Risk factors for palatal and orbital involvement in mucormycosis epidemic–Report of a center in India

Bhat, Vikram Kemmannu; Bongale, Kiran Ravindranath; Basti, Shriya Pramod; Gadag, Raveendra P.; Kizhakkilottu, Nikhila; Sebastian, Eaiby; Gopalegowda, Megha Kattayya; Thammaiah, Pavithra

doi:10.1016/j.amjoto.2021.103371

Cited by 2 publications

(2 citation statements)

References 40 publications

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“…Hence, many experts are currently occupied with providing an evidence-based knowledge on CAM’s presentations, clinical course, and prognosis. 8 - 11 Our observations in the neurology clinic also indicated a difference in neurological courses of CAM and COVID-19-unrelated ROCM. Hence, in this study, we aimed to address the lack of evidence by comparing the CAM and ROCM from a neurological perspective.…”

Section: Introductionmentioning

confidence: 55%

Neuro-mucormycosis: Lessons from COVID-19-associated cases

Sedaghat,

Etemadifar,

Ghasemi

et al. 2023

CJN

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Background: Scarce data are available on the neurological presentations of coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) and COVID-19-unrelated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to compare the neurological presentations and their associated outcomes in patients with CAM and COVID-19-unrelated ROCM. Methods: In December 2021, a case-control analysis was conducted on the CAM (case group) and COVID-19-unrelated ROCM (control group) referrals of one center in Isfahan, Iran. Confirmed CAM patients from January 2020 to December 2021 constituted the case group, and patients with COVID-19-unrelated ROCM from 2016-2019 constituted the control group. Their data were then analyzed using proper (non) parametric tests and generalized linear models (GLM), therein P-value below 0.05 was considered as the criterion of statistical significance, and the SPSS software was used. Results: After retrieving data on 177 patients with mucormycosis, 78 patients with CAM were included as the case group and 72 patients with COVID-19-unrelated ROCM were included as the control group. Neurological presentations suggestive of second, third, and eighth cranial nerve involvement were more prevalent in the CAM group (all with P < 0.05). The mortality rate in the CAM group was 1.9 times that of the controls (P = 0.01), being explained by higher extent of corticosteroid administration among them. Higher age and presentation with gait ataxia, ptosis, and mydriasis were considered to be predictive of poor prognosis in patients with CAM (all with P < 0.05). Conclusion: The neurological manifestations of CAM differ from COVID-19-unrelated ROCM based on the presented results, some of which are associated with poor prognosis. Further replication is warranted to confirm our retrospective analyses.

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Section: Introductionmentioning

confidence: 55%

Neuro-mucormycosis: Lessons from COVID-19-associated cases

Sedaghat,

Etemadifar,

Ghasemi

et al. 2023

CJN

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“…In addition, studies including patients with invasive fungal infections in general, and not mucormycosis specifically, and studies including mucormycosis cases not associated with COVID-19 and not separately with CAM cases were excluded. Sixteen studies were excluded due to unavailable–insufficient information [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Four studies were excluded as they included patients with non-microbiologically confirmed SARS-CoV-2 infection [ 25 , 26 , 27 , 28 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

et al. 2022

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A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements.

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Risk factors for palatal and orbital involvement in mucormycosis epidemic–Report of a center in India

Cited by 2 publications

References 40 publications

Neuro-mucormycosis: Lessons from COVID-19-associated cases

Neuro-mucormycosis: Lessons from COVID-19-associated cases

Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

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