Rhino-orbito-cerebral mucormycosis and its resurgence during COVID-19 pandemic: A review

Abstract

This study aimed to review the current literature for epidemiology, pathogenesis, clinical spectrum and management of rhino-orbito-cerebral-mucormycosis (ROCM), especially highlighting the association between ROCM and COVID-19 disease and factors resulting in its resurgence during the pandemic. Mucormycosis is a rare, but an important emerging opportunistic fungal infection, often associated with high morbidity and mortality. ROCM is the commonest and also the most aggressive clinical form occurring in debilitated patients in conjunction with sinus or para-sinus involvement due to the propensity for contiguous spread. Recently ROCM has shown an unprecedented resurgence during the current pandemic. Reports from different parts of the world indicated an increased risk and incidence of ROCM in patients who had required hospital admission and have recovered from moderate-to-severe COVID-19 disease. A majority of mucormycosis cases have been reported from India. The presence of diabetes mellitus (DM) and use of corticosteroids for COVID-19 pneumonia were found to be the key risk factors, resulting in higher mortality. Amidst the ongoing pandemic, with the third wave already having affected most of the world, it becomes imperative to adopt a risk-based approach toward COVID-19 patients predisposed to developing ROCM. This could be based on the most recently published literature and emerging data from centers across the world. The present review intended to elucidate the causes that brought about the current spike in ROCM and the importance of its early detection and management to reduce mortality, loss of eye, and the need for mutilating debridement.

Mucormycosis: A 14-Year Retrospective Study from a Tertiary Care Center in Lebanon

“…The most frequently observed findings of ROCM were orbital invasion, followed by mucoperiosteal thickening and severe soft tissue edema. Approximately half of the diagnosed patients with ROCM exhibited orbital involvement, which aligns with findings from the literature [ 57 , 58 , 59 ]. The pterygopalatine fossa serves as a crucial pathway for the spread of MCM to the orbital, facial, and intracranial regions [ 60 ].…”

Manifestações clínicas bucais relacionada a COVID-19

“…Há também relatos na literatura de presença de celulite orbitária, alterações no sistema nervoso central e pulmão na presença dessa infecção. As complicações sistêmicas advindas da infecção de mucormicose acontecem devido a angioinvasão, trombose vascular e necrose tecidual generalizada (JANJUA et al, 2021;PAI et al, 2021;KARKHUR et al, 2023).…”