Spike in Rhino-Orbital-Cerebral Mucormycosis Cases Presenting to a Tertiary Care Center During the COVID-19 Pandemic

Abstract

Objective: To determine if there was an increase in the rate of cases presenting with rhino-orbital-cerebral mucormycosis (ROCM) to a tertiary care center during the first wave of the coronavirus disease 2019 (COVID-19) pandemic and the characteristics of the presenting cases.Methods: Retrospective observational study reviewing ROCM cases presenting from March 25 until September 25, 2020. Cases fulfilling the clinical, radiological, and pathological/microbiological criteria for diagnosis with ROCM were included. The number of cases presenting during the designated interval, their COVID-19 status, comorbidities, and clinical presentation were analyzed. The number of cases during the corresponding interval in the previous 3 years was used as reference to detect if there was a recent spike.Results: Of the 12 ROCM cases identified, 5 had a concurrent positive reverse transcription PCR (RT-PCR) test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 had a prior positive result, and 6 did not have concurrent nor prior positive test results. Nine of the 12 cases had poorly controlled diabetes mellitus, and 2 cases had a hematological malignancy. All cases had orbital invasion, and eight cases had cerebral invasion. The number of cases identified during the interval is much higher than the numbers presenting in the prior 3 years during equivalent intervals (range, one to two cases) than those reported in the literature in different settings in the pre-pandemic era.Conclusions: There is an increased rate of ROCM cases presenting to our center during the first wave of the COVID-19 pandemic. This is a preliminary report, and further studies are needed to corroborate the findings and explain possible underlying links.

Rhino-orbital-cerebral-mucormycosis in COVID-19: A systematic review

“…Nearly 53.7% of ROCM cases were associated with a significant loss of vision. [ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] Similarly percentage of occurrence of ophthalmoplegia among COVID-19 associated ROCM were 61.68%, lid oedema 60.6%. Proptosis were seen in 60.6%, facial oedema 34.7%, ptosis 72.7%, pupil involvement was seen in 58.1% ROCM patients.…”

“…A total of 15 studies were included in the final analysis. Except four studies[ 15 16 17 18 ] all the other studies[ 19 20 21 22 23 24 25 26 27 28 29 ] studies were from Indian population from different zone of India. Among all 4[ 17 22 25 27 ] are case series and all other are observational study.…”

“…Commonest clinical feature at presentation were nasal block, ocular pain, or swelling of lid in all the included studies. [ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] Apart from these, rare presentations like sudden loss of vision was also seen as presenting feature. [ 21 ] Bilateral eye involvement reported in small number of patients (single study[ 18 ] 2 out of 12 patients, i.e., 16.7% bilateral involvement of eye) and maximum study reported unilateral involvement.…”

“…[ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] Apart from these, rare presentations like sudden loss of vision was also seen as presenting feature. [ 21 ] Bilateral eye involvement reported in small number of patients (single study[ 18 ] 2 out of 12 patients, i.e., 16.7% bilateral involvement of eye) and maximum study reported unilateral involvement. Nearly 53.7% of ROCM cases were associated with a significant loss of vision.…”

“…KOH positivity were seen in 62% patients. [ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] Among the fungal culture mucorale were isolated in 59.3% of fungal culture mucorale were isolated in 59.3% of fungal culture and Rhizopus species were the commonest species identified consisted of 44.8% of total fungal culture[ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] while mixed fungal growth was seen in 3.9% growth and bacterial co infection has been reported in 36.3% culture [ Table 1 ].…”