Rhino-orbito-cerebral Mucormycosis: Pictorial Review

Abstract

Mucormycosis (MCR) is a fulminant, potentially lethal, opportunistic fungal infection. Diabetes, immunocompromised states and elevated serum iron levels are the most important risk factors for contracting MCR infection. Recently, MCR co-infections have been observed in patients with COVID-19 disease owing to a complex interplay of metabolic factors and corticosteroid therapy. Rhino-orbito-cerebral mucormycosis (ROCM) is the most common clinical form of MCR infection and refers to infection of the nasal cavities, paranasal sinuses, neck spaces, orbits and intracranial structures. Sinonasal inoculation is typically the primary site of infection; the necrotising and angioinvasive properties of the fungus facilitate its spread into adjacent structures. In this review, we discuss the pertinent mycology and risk factors of MCR infection. The review also aims to acquaint the reader with the cross-sectional imaging appearances of ROCM and its complications. All the cases discussed in this pictorial essay are microbiologically and/or histopathologically proven cases of ROCM with concomitant COVID-19 infection.

Diabetes mellitus and other underlying conditions in patients with coronavirus disease 2019 associated rhino-orbito-cerebral mucormycosis: a systematic review and meta-analysis

“…The incidence of orbital involvement in cases with rhino-orbito-cerebral mucormycosis was reported to be 76 to 80 per cent in previous studies. 33 In the current study, the prevalence of orbital involvement was 61 per cent. The frequency of cerebral involvement in Covid-19-associated rhino-orbito-cerebral mucormycosis was reported to be 22 per cent.…”

COVID-19 associated rhino orbital mucormycosis : Single center experience of 21 cases

“…Cutaneous involvement warranted extensive debridement of premaxillary tissues and maxillectomy, with reconstruction later. The intracranial spread is indicated by focal neurological signs 8 . Despite maximum surgical debridement and antifungal therapy 60 % mortality rate was observed in patients with cerebral involvement 9 .…”

Estimation of Serum Levels of Heavy Metals in Patients with Chronic Invasive Fungal Rhinosinusitis Before the COVID-19 Era: A Pilot Study

“…Acute inflammatory markers like ESR and CRP are commonly used parameters for prognostication in invasive fungal sinusitis. In addition to this, poor glycemic control is also one of the risk factors for developing invasive fungal disease ( 23 , 24 ). We compared the levels of heavy metals based on ESR, CRP, and HbA1c as we expected a positive correlation between these parameters and the levels of those heavy metals which are possibly involved in the pathogenesis of CIFR; however, we did not find any correlation.…”