1
|
Chen A, Pietris J, Bacchi S, Chan W, Psaltis AJ, Selva D, Lim W. Imaging Features of Invasive Fungal Rhinosinusitis: A Systematic Review. Can Assoc Radiol J 2024; 75:601-608. [PMID: 38344986 DOI: 10.1177/08465371241227424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
Fungal rhinosinusitis (FRS) includes non-invasive and invasive subtypes with the latter having significant morbidity and mortality. This systematic review aims to identify the imaging features most correlated with invasive fungal rhinosinusitis (IFRS) and present a checklist of these features to aid diagnosis. PubMed, Embase, CENTRAL, and Science Direct were searched from inception to May 2023, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Primary research articles published in English describing the imaging features of IFRS were included. The systematic review was conducted in accordance with the PRISMA guidelines. Forty-eight articles were identified for inclusion. Six studies examined radiological features in acute invasive fungal rhinosinusitis (AIFRS), and 9 studies of chronic invasive fungal rhinosinusitis (CIFRS). A majority of studies did not specify whether IFRS cases were acute or chronic. On CT, bony erosion and mucosal thickening were the most common features. Other features include nasal soft tissue thickening, nasal cavity opacification, opacification of the affected sinus, and perisinus soft tissue infiltration. Extra-sinus extension was commonly observed on MRI, most often invading intraorbitally and intracranially. Other sites of extra-sinus extension included the cavernous sinus, pterygopalatine fossa, infratemporal fossa, masticator space, and facial soft tissue. IFRS is a condition with potential for high morbidity and mortality. Several radiological features are highly suggestive of IFRS. Early identification of high-risk radiological features using a checklist may aid prompt diagnosis and early treatment. Future research investigating the radiological differentiation between IFRS and other significant pathology including bacterial orbital cellulitis would be beneficial.
Collapse
Affiliation(s)
- Anni Chen
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Radiology, University of Adelaide, Adelaide, SA, Australia
| | - James Pietris
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, SA, Australia
- Department of Neurology, University of Adelaide, Adelaide, SA, Australia
| | - WengOnn Chan
- Royal Adelaide Hospital, Adelaide, SA, Australia
- South Australian Institute of Ophthalmology, University of Adelaide, SA, Australia
- Department of Ophthalmology, University of Adelaide, Adelaide, SA, Australia
| | - Alkis J Psaltis
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Dinesh Selva
- Royal Adelaide Hospital, Adelaide, SA, Australia
- South Australian Institute of Ophthalmology, University of Adelaide, SA, Australia
- Department of Ophthalmology, University of Adelaide, Adelaide, SA, Australia
| | - WanYin Lim
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Radiology, University of Adelaide, Adelaide, SA, Australia
- Jones Radiology, Eastwood, SA, Australia
| |
Collapse
|
2
|
Aksoy M, Ozcan AA, Ulas B. Prognostic factors and clinical features of rhino-orbital-mucormycosis cases: an update for patient and visual survivals. Int J Ophthalmol 2024; 17:916-923. [PMID: 38766351 PMCID: PMC11074210 DOI: 10.18240/ijo.2024.05.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 02/02/2024] [Indexed: 05/22/2024] Open
Abstract
AIM To determine the frequency of patients' vision survival and prognostic factors and evaluate clinical features in rhino-orbital mucormycosis. METHODS Forty-three eyes of 43 patients followed up with orbital mucormycosis infections were included in the study. Demographic characteristics of the patients, symptoms at admission, ophthalmologic and non-ophthalmologic examination findings, clinical findings during follow-up, medical and surgical procedures, and complications were recorded. Patient survival was determined by assessing the incidence of mortality, and vision survival was defined as achieving a final visual acuity of at least light perception. RESULTS Twenty-seven (62.8%) patients were male, and 16 (37.2%) were female. When the underlying disease status of the patients was examined, it was observed that all patients had an underlying disease and diabetes constituted the majority (65.2%). Periorbital swelling (69.8%) and ophthalmoplegia (53.5%) were the most common symptoms and findings at the admission of patients with mucormycosis infection. The disease resulted in death in 22 (51.2%) patients. The presence of fever and shorter duration of antifungal therapy were associated with lower patient survival. Exenteration surgery was not found to be associated with the survival of the patients. Frozen eye, loss of pupillary light reflex, and development of central retinal artery occlusion were associated with lower vision survival. CONCLUSION This study presents one of the most extensive patient series in the literature on rhino-orbital mucormycosis. Knowing the patients' symptoms at the time of admission and the clinical findings during the infection process will increase awareness about the disease.
Collapse
Affiliation(s)
- Mustafa Aksoy
- Department of Ophthalmology, Cukurova University Faculty of Medicine, Saricam, Adana 01330, Türkiye
| | - Altan Atakan Ozcan
- Department of Ophthalmology, Cukurova University Faculty of Medicine, Saricam, Adana 01330, Türkiye
| | - Burak Ulas
- Department of Ophthalmology, Cukurova University Faculty of Medicine, Saricam, Adana 01330, Türkiye
| |
Collapse
|
3
|
Kumar S, Anita, Dev A, Kumar A, Kumar Nayan S, Singh S. The Study of Clinical Profile of Patients With Mucormycosis During COVID-19 Pandemic in Tertiary Care Hospital. Cureus 2023; 15:e47065. [PMID: 38021649 PMCID: PMC10651161 DOI: 10.7759/cureus.47065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Mucormycosis has gained a huge number of cases in the second wave of post COVID-19 infection, which may be attributed to increased awareness, advancement in diagnostic techniques, and an increase in the prevalence of predisposing factors. This study evaluated the pattern, risk factors, and clinical profile of patients with mucormycosis during the second wave of the COVID-19 pandemic. METHODS A prospective observational study was conducted in the Department of Emergency Medicine of a dedicated tertiary care hospital for COVID-19. The Institutional Ethics Committee approved the study. One hundred five patients diagnosed with mucormycosis were included from June 2021 to December 2021. Informed consent was obtained from the patients. Data on demography, clinical features, predisposing factors, co-morbid conditions, and microbiological samples were obtained and analyzed. RESULTS Out of 105 patients, 71 were male, and 34 were female. The patient presented with mucormycosis between the 2nd and 3rd week of post COVID-19 infection. Incidence was mainly seen in patients in their fifties, mostly associated with diabetes mellitus (DM) (53.30%), oxygen administration (80%), and previous use of steroids (45.71%). Predominantly, males were more affected. The most common presentation was headache (50.47%), orbital pain with restricted ocular movement (47.67%), proptosis (42.85%), and diminished vision (41.90%). Rhino-orbital-cerebral mucormycosis (ROCM) was the most common presentation of mucormycosis, while only five cases of pulmonary mucormycosis were found. CONCLUSION ROCM was the most common presentation of mucormycosis between the second and third week of post COVID-19 infection. Diabetes mellitus and inadvertent use of steroids were major predisposing factors. Therefore, a high degree of suspicion and early diagnosis with initiation of treatment is warranted in cases of mucormycosis in post COVID-19 infection.
Collapse
Affiliation(s)
- Santosh Kumar
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Anita
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Anand Dev
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Abhay Kumar
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | | | - Siddharth Singh
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| |
Collapse
|
4
|
Malipedda SK, Sudhakar P, Thangella L, Vorem D, Sattaru P. 18-F Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a Rare Case of Post-COVID-19 Mucormycosis of Femur. Indian J Nucl Med 2023; 38:160-161. [PMID: 37456191 PMCID: PMC10348495 DOI: 10.4103/ijnm.ijnm_182_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 07/18/2023] Open
Abstract
COVID-19 disease was spread rapidly on a global scale. Corticosteroids were believed to reduce the inflammatory lung injury, however, its side effects include increased secondary infections, immunomodulation, and manifestation of latent diabetes mellitus. The incidence of mucormycosis infection was high in post COVID-19-infected patients. Mucormycosis of femur in patients of post-COVID-19 infection was extremely rare and not yet reported. We report a case of COVID-19 recovered patient with mucormycosis of right distal femur, who underwent 18Ffluorodeoxyglucose (18FFDG) positron emission tomography/computed tomography (PET/CT) for additional sites of disease. This case highlights potential of 18FFDG PET/CT in the management of mucormycosis.
Collapse
Affiliation(s)
- Suneel Kumar Malipedda
- Department of Nuclear Medicine, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Pushpalatha Sudhakar
- Department of Nuclear Medicine, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Likitha Thangella
- Department of Nuclear Medicine, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Dinesh Vorem
- Department of Nuclear Medicine, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Padmavathi Sattaru
- Department of Nuclear Medicine, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| |
Collapse
|
5
|
Hanumappa SM, Karuppannasamy D. Clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of COVID-19: A retrospective study. Saudi J Ophthalmol 2023; 37:100-106. [PMID: 37492213 PMCID: PMC10365243 DOI: 10.4103/sjopt.sjopt_155_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/09/2022] [Indexed: 07/27/2023] Open
Abstract
PURPOSE The purpose was to study the demographics, clinical and radiological presenting patterns, prognostic variables, and outcome of management of rhino-orbital-cerebral-mucormycosis (ROCM) in coronavirus disease (COVID-19) patients. METHODS We retrospectively analyzed COVID-19 patients with proven ROCM from April 2021 to November 2021. All included patients were given systemic antifungal therapy depending on clinical response and underwent functional endoscopic sinus surgery (FESS) with orbital wall decompression. Administration of transcutaneous retrobulbar amphotericin B (TRAMB) injection, exenteration, and maxillectomy was done when indicated as per a novel algorithm. RESULTS A total of 64 patients with ROCM were included in the study. The mean age of 54.5 (standard deviation [SD] - 10.6) years with a male predominance (male: female = 55:9) was observed. Pre-existing diabetes mellitus (DM) was the most common comorbid state, 47 (73.4%). The most common ophthalmic presentation was proptosis (n = 40) (62.5%). Bulky extraocular muscles (n = 64) (100%) and intraorbital fat stranding (n = 41) (64%) were the most common radiological findings. Twenty-eight patients received TRAMB, while 11 patients underwent exenteration with FESS. Our study had a mortality rate of 18.7% (n = 12). The mean glycated hemoglobin of 13.5% (SD - 1.1) and a higher serum ferritin value of 976.25 (SD - 592) were observed in the deceased group. Vision was preserved in 38 (73.7%) patients in the survived group. CONCLUSION ROCM has a wide array of presentations, with proptosis as the most common clinical finding. Bulky EOM and intraorbital fat stranding were the most common radiological findings. Thorough surgical debridement with systemic and local antifungal therapy results in reasonable outcomes for ROCM in COVID-19 patients. Older age, intensive care unit admissions, uncontrolled DM, central nervous system involvement, and shorter duration of antifungal treatment are poor prognostic factors associated with mortality.
Collapse
|
6
|
Pérez MA, Martínez L, Bravo J, Rodríguez B, Quintero P, Moncada P. Infection due to Aspergillus flavus and Rhizopus oryzae complex in a patient with diabetes mellitus. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:27-36. [PMID: 37167471 PMCID: PMC10470490 DOI: 10.7705/biomedica.6358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/04/2023] [Indexed: 05/13/2023]
Abstract
Fungal sinusitis is a pathology that can occur in patients with diabetes mellitus and be associated with a hyperglycemic crisis. It is an aggressive entity with local complications that include involvement of the orbit or the central nervous system, and vascular involvement. Despite surgical and antifungal treatment, mortality raises up to 75%. We report the case of a female patient with a diagnosis of diabetic ketoacidosis and signs of unilateral ophthalmoplegia, which led to the study with magnetic resonance imaging of the central nervous system, finding signs of sinusitis, meningitis, and cerebritis. Initial microbiological studies were negative, and biomarkers such as serum galactomannan and Cryptococcus antigen were also negative. After surgical management and the identification of Aspergillus flavus and Rhizopus spp. in sinus tissue, the patient received treatment with posaconazole and after two months of follow-up she presented clinical improvement. Dual fungal infection and infection by A. flavus are uncommon and clinically relevant entities, with no cases previously reported in our country, therefore this corresponds to a case of clinical interest.
Collapse
Affiliation(s)
| | - Luisa Martínez
- Departamento de Microbiología, Fundación Valle del Lili, Cali, Colombia.
| | - Juan Bravo
- Departamento de Patología, Fundación Valle del Lili, Cali, Colombia.
| | - Brenda Rodríguez
- Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia.
| | - Paola Quintero
- Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia.
| | - Pablo Moncada
- Departamento de Infectología, Fundación Valle del Lili, Cali, Colombia.
| |
Collapse
|
7
|
Boiko NV, Kolesnikov VN, Khanamirov AA, Lapin MA, Miroshnichenko DI, Stagnieva IV, Pisarenko EA, Anisimova AG. [COVID-19 associated sino-orbital mucormycosis]. Vestn Otorinolaringol 2023; 88:31-37. [PMID: 37184552 DOI: 10.17116/otorino20228802131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To analyze the dynamics of symptoms in patients with COVID-19 associated sino-orbital mucormycosis. MATERIAL AND METHODS We describe a series of 13 patients with COVID-19 associated sino-orbital mucormycosis aged 43 to 80 years diagnosed from August to October 2021. All of the patients had a severe disease and required noninvasive ventilation or intubation and administration of dexamethasone. 12 out of 13 patients (92.3%) suffered from diabetes mellitus. Symptoms of fungal infections of the nose and paranasal sinuses appeared in the interval from 7 to 25 days of hospital stay, most often in the second week (from 8 to 12 days). According to clinical and CT features the patients were divided into three groups, combining similar phenotypes of the disease. Group 1 - 1 patient with sinonasal mucormycosis, destruction of the alveolar ridge and the hard palate. Group 2 - 12 patients with sino-orbital mucormycosis. We noted, that in cases of bilateral sinus lesions orbital complications were unilateral in all patients, on the side of more severe lesion. Group 2 was divided into 2 subgroups: subgroup 2a included 2 patients with the superior orbital fissure syndrome: ptosis, proptosis, ophthalmoplegia, periorbital pain, pain or hypoesthesia of half face; subgroup 2b included 10 patients with the orbital apex syndrome, who, in addition to the above symptoms, had loss of vision and conjunctival chemosis. Group 3 - rhino-sino-cerebral mucormycosis. 2 patients from subgroup 2b were transferred to this group due to the intracranial spread of the process and focal neurological symptoms. CONCLUSION Clinical forms of mucormycosis reflect successive stages of invasive spread of fungi.
Collapse
Affiliation(s)
- N V Boiko
- Rostov State Medical University, Rostov-on-Don, Russia
| | | | - A A Khanamirov
- Rostov Regional Clinical Hospital, Rostov-on-Don, Russia
| | - M A Lapin
- Rostov Regional Clinical Hospital, Rostov-on-Don, Russia
| | | | - I V Stagnieva
- Rostov State Medical University, Rostov-on-Don, Russia
| | - E A Pisarenko
- Regional Consultative and Diagnostic Center, Rostov-on-Don, Russia
| | - A G Anisimova
- Rostov Regional Clinical Hospital, Rostov-on-Don, Russia
| |
Collapse
|
8
|
Singla N, Sharma N, Sharma N, Behera A, Bhatia M. Clinical Profile of Patients Admitted With Mucormycosis During the COVID-19 Pandemic in Medicine Emergency of a Tertiary Care Hospital in North India. Cureus 2022; 14:e29219. [PMID: 36159346 PMCID: PMC9495285 DOI: 10.7759/cureus.29219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 12/15/2022] Open
|
9
|
Bougioukas L, Noyes CD, Peterson K, Smith LM, Hale AJ. Successful treatment of rhino-cerebral mucormycosis with dual antifungal therapy and minimal surgical debridement. IDCases 2022; 30:e01615. [PMID: 36119757 PMCID: PMC9474854 DOI: 10.1016/j.idcr.2022.e01615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 01/09/2023] Open
Abstract
The authors report the case of a 42-year-old female with history of type I diabetes mellitus and recent episode of diabetic ketoacidosis who presented with symptoms of epistaxis, gastrointestinal upset, hyperglycemia, confusion, and a cough. She was found to have rhino-cerebral mucormycosis with associated multi-focal strokes and a left internal carotid artery pseudoaneurysm. Her infection was successfully treated with dual-antifungal therapy consisting of liposomal amphotericin B and isavuconazole, and required only minimal surgical debridement.
Collapse
Affiliation(s)
| | - Cindy D. Noyes
- University of Vermont Medical Center, Burlington, VT, USA,Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | | | - Lindsay M. Smith
- University of Vermont Medical Center, Burlington, VT, USA,Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Andrew J. Hale
- University of Vermont Medical Center, Burlington, VT, USA,Larner College of Medicine at the University of Vermont, Burlington, VT, USA,Correspondence to: University of Vermont Medical Center, Infectious Disease Unit, 111 Colchester Avenue, Mailstop 115 SM2, Burlington, VT 05401, USA.
| |
Collapse
|
10
|
Atypical presentations of fungal osteomyelitis during post COVID-19 outbreak – Case series. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2022; 34:622-627. [PMID: 35402152 PMCID: PMC8977445 DOI: 10.1016/j.ajoms.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/06/2022] [Accepted: 03/11/2022] [Indexed: 11/20/2022]
Abstract
Introduction Mucormycosis and Aspergillosis are opportunistic fungal infections causing significant morbidity and mortality. Post the outbreak of COVID-19, these fungal osteomyelitis have seen a global rise with few atypical presentations noted. Case report Current case series reports three such atypical presentations of fungal osteomyelitis including mandibular fungal osteomyelitis in two patients, fungal osteomyelitis mimicking space infection in a middle aged male, and suspected mixed fungal osteomyelitis involving maxillary sinus. Aggressive surgical debridement was indicated along with institution of antifungal therapy (Liposomal Amphotericin B, and Posaconazole). The fungal osteomyelitis was successfully treated with surgical and medical management with no recurrence. Discussion The injudicious use of corticosteroids in COVID-19 patients along with their immunocompromised status increases their susceptibility to opportunistic fungal osteomyelitis. Prompt and aggressive surgical intervention along with antifungal therapy is important after diagnosing fungal osteomyelitis, as a delay could increase the mortality rate considerably.
Collapse
|
11
|
Sree Lakshmi I, Kumari BS, Jyothi C, Devojee M, Padma Malini K, Sunethri P, Bheemrao Somalwar S, Kavitha T. Histopathological Study of Mucormycosis in Post COVID-19 Patients and Factors Affecting it in a Tertiary Care Hospital. Int J Surg Pathol 2022; 31:56-63. [PMID: 35668640 PMCID: PMC9177820 DOI: 10.1177/10668969221099626] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction. COVID-19 is an infection caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) which may be associated with a wide range of bacterial and fungal co-infections. Mucormycosis is an opportunistic fungal infection occurring in post COVID-19 patients. Objectives. To study the role of histopathology in mucormycosis and the predisposing factors associated in development of mucormycosis in post COVID-19 patients. Materials and methods. A prospective observational study was conducted in our hospital in the pathology department over a period of 3 months on 200 patients with mucormycosis who were infected with SARS-CoV-2 virus. Results. Out of the 200 patients with mucormycosis studied in post COVID-19 patients, age ranged from 21-80 years, of which 132 were men and 68 were women. Sites involved by mucormycosis were sinuses, orbit, cranium, and cutaneous. Ethmoid sinus was most involved, followed by maxillary sinus. Diabetes was present in 162 patients and hypertension in 92 patients. On histopathological examination, fungal load was severe in 49 patients, angioinvasion was present in 48 patients, perineural invasion was present in 32 patients, and necrosis was present in 121 patients. The number of patients discharged after surgery was 169, whereas 31 died. Conclusion. Histopathological features of mucormycosis like angioinvasion, perineural invasion, severe fungal load, and large areas of necrosis were directly proportional to the mortality rate. Thus, histopathologists can help in assessing prognosis at the time of tissue diagnosis, so that clinicians can optimize treatment accordingly. Diabetes and history of corticosteroid intake for treatment of COVID-19 were the two commonest predisposing factors for development of mucormycosis.
Collapse
Affiliation(s)
- I. Sree Lakshmi
- Dept of Pathology,
Gandhi Medical
College & Hospital,
Secunderabad-Padmarao Nagar, Telangana, India
| | - B. Swapna Kumari
- Dept of Pathology,
Gandhi Medical
College & Hospital,
Secunderabad-Padmarao Nagar, Telangana, India,B. Swapna Kumari, Dept of Pathology, Gandhi
Medical College/Hospital, Musheerabad, Padmarao Nagar, Secunderabad, Telangana –
500003, India. Email id:
| | - Ch. Jyothi
- Dept of Pathology,
Gandhi Medical
College & Hospital,
Secunderabad-Padmarao Nagar, Telangana, India
| | - M. Devojee
- Dept of Pathology,
Gandhi Medical
College & Hospital,
Secunderabad-Padmarao Nagar, Telangana, India
| | - K. Padma Malini
- Dept of Pathology,
Gandhi Medical
College & Hospital,
Secunderabad-Padmarao Nagar, Telangana, India
| | - Padma Sunethri
- Dept of Pathology,
Gandhi Medical
College & Hospital,
Secunderabad-Padmarao Nagar, Telangana, India
| | | | - T. Kavitha
- Dept of Pathology,
Gandhi Medical
College & Hospital,
Secunderabad-Padmarao Nagar, Telangana, India
| |
Collapse
|
12
|
Mucormycosis, a post-COVID infection: possible adjunctive herbal therapeutics for the realigning of impaired immune-metabolism in diabetic subjects. HERBA POLONICA 2022. [DOI: 10.2478/hepo-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Summary
Cytokine storm is believed as a major root cause for multi-organ failure and death in severely infected diabetic patients with COVID-19. This condition is treated with anti-inflammatory drugs, mainly steroids, to recover people from critical conditions. However, steroid therapy causes immune suppression and uncontrolled hyper-glycaemia in post-COVID. This altered immune-metabolism provides a fertile environment for the infection of a black fungus, Rhizopus arrhizus which causes mucormycosis in diabetic patients. It is a life-threatening infection causing death in different countries. It is treated either with anti-fungal drugs, surgical debridement, or adjunctive therapies. The available therapies for mucormycosis have been associated with several drawbacks. Thus, the present review has explored and suggested herbs-spices based adjunctive therapy for possible realignment of the impaired immune system in the post-COVID diabetic subjects. The consumption of herbal therapeutics after COVID-19 could realign the impaired immune-metabolism in the post-COVID and thereby exert prophylactic effects against mucormycosis. Furthermore, the suggested herbal sources could help in the discovery of novel therapeutics against the COVID-19 associated mucormycosis.
Collapse
|
13
|
Esteak T, Shah R, Tosaddeque M, Behram S, Nasir M. Mucormycosis in Different Clinical Settings: A Case Series. Cureus 2022; 14:e24419. [PMID: 35637825 PMCID: PMC9126598 DOI: 10.7759/cureus.24419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/13/2022] Open
Abstract
Mucormycosis is a fungal infection that can be very destructive and often fatal. People most prone to this infection include those who are immunocompromised. Early diagnosis and treatment, along with addressing the risk factors, play a pivotal role in the management. Here, the authors are reporting three cases of immunocompromised patients. Among them, two had uncontrolled diabetes, and the third had a history of renal transplant and COVID-19 infection. All three cases are distinct anatomically; one is pulmonary, one is rhino-orbital-cerebral, and the last one is rhino-maxillary.
Collapse
|
14
|
Saluja G, Bhari A, Pushker N, Agrawal S, Meel R, Thakar A, Xess I, Khandelwal A, Narwal A, Bajaj MS. Experience on rhino-orbital mucormycosis from a tertiary care hospital in the first wave of COVID-19: An Indian perspective. Med J Armed Forces India 2022; 79:S0377-1237(22)00009-0. [PMID: 35400798 PMCID: PMC8975717 DOI: 10.1016/j.mjafi.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/18/2022] [Indexed: 12/27/2022] Open
Abstract
Background To highlight the clinical presentations and management outcomes of rhino-orbital mucormycosis during first wave of COVID-19 pandemic in North India. Methods A retrospective observational study. 15 patients with mucormycosis (orbital disease) who presented during short span of 3 months (October-December 2020) in a tertiary-care referral institution were analysed. Results At presentation, 13 of 15 patients had uncontrolled diabetes. Four had history of COVID-19 infection. All patients had advanced orbital disease with sinusitis; cavernous sinus involvement was in nine and intracranial spread in three patients. Liposomal amphotericin-B was started and prompt orbital exenteration with sinus surgery was performed in 12 patients. All 12 patients survived with an average follow-up of 4.8 months. Conclusion In the present series, cases with orbital spread of mucormycosis were mostly found in non-COVID uncontrolled diabetics. Exenteration was done in 80% of cases with advanced orbital disease. Prevention and early detection of infection at the stage of sino-nasal involvement might help to prevent spread and/or halt the orbital disease.
Collapse
Affiliation(s)
- Gunjan Saluja
- Senior Resident, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Anju Bhari
- Senior Resident, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Neelam Pushker
- Professor, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Sahil Agrawal
- Senior Research Officer, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rachna Meel
- Professor, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Alok Thakar
- Professor (Otolaryngology), AIIMS, New Delhi, India
| | | | | | | | - Mandeep S. Bajaj
- Professor, Oculoplastics, Tumor & Pediatric Ophthalmology Services, Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| |
Collapse
|
15
|
Chussi DC, Kayuza M, Magwizi M, Shija P, Sadiq A, Amsi P, Katundu D, Mtenga P. Rhinocerebral mucormycosis in a diabetes type 2 patient: A fatal case report from northern Tanzania. SAGE Open Med Case Rep 2022; 10:2050313X221078721. [PMID: 35223035 PMCID: PMC8864275 DOI: 10.1177/2050313x221078721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/20/2022] [Indexed: 11/15/2022] Open
Abstract
Mucormycosis is an acute and aggressive fungal infection usually, but not exclusively,
occurring in immunocompromised individuals. Lack of knowledge and awareness in developing
countries hinders timely management. This case highlights the importance of a prompt index
of suspicion for the timely and aggressive intervention of mucormycosis to the Tanzanian
community. We report a case of fatal rhino-orbital-cerebral mucormycosis in a diabetic
patient presenting at a tertiary hospital in the Kilimanjaro region, Tanzania. Nasal
deformity, proptosis, chemosis and left-sided hemiplegia were evident on physical
examination. Nasoendoscopy revealed extensive necrosis of the nasal septum, inferior
turbinate and involvement of the frontal recess. Computed tomography and magnetic
resonance imaging of the paranasal sinuses and head revealed necrosis and ischemic changes
due to fungal invasion. The patient deceased due to intracranial complications of advanced
fungal invasion. Late presentation and unacquainted with mucormycosis our patient had an
unfavourable outcome. Early diagnosis, extensive surgical debridement and a
multidisciplinary approach to treatment are of the essence in favour of a better
prognosis.
Collapse
Affiliation(s)
- Desderius Celestine Chussi
- Department of Otorhinolaryngology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael Kayuza
- Department of Otorhinolaryngology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Marco Magwizi
- Department of Otorhinolaryngology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Peter Shija
- Department of Otorhinolaryngology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Adnan Sadiq
- Department of Radiology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Patrick Amsi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Denis Katundu
- Department of Otorhinolaryngology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Philbert Mtenga
- Department of Otorhinolaryngology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| |
Collapse
|
16
|
Mardani M, Alavi Darazam I, Babamahmoodi A. Dexamethasone Induced Sino-Orbital Mucormycosis In a Patient Infected With COVID-19. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:277-280. [PMID: 35872692 PMCID: PMC9272951 DOI: 10.22088/cjim.13.0.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/01/2021] [Accepted: 12/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The most common causes of immunodeficiency are iatrogenic and the result of the widespread use of therapies which modulates the immune system, whether they are planned or haphazardly. Mucormycosis is an invasive fungal disease which is usually secondary to immunosuppression, diabetic ketoacidosis, and long-term use of antibiotics, corticosteroids, and cytotoxic drugs. There are researches which show patients with coronavirus disease 2019 (COVID-19), especially severely ill or immunocompromised, are more likely to suffer from invasive fungal infections. Patients with diabetes are at a higher risk for severe COVID-19 outcomes. However, there has been no clear evidence on the relationship between pre-diabetes state and mucormycosis as a complication of SARS-CoV-2 infection so far. CASE PRESENTATION Here, we report a case of sino-orbital mucormycosis in a pre-diabetic 54-year-old female without any underlying diseases. The patient suffered from COVID-19 pneumonia. She received 8 mg dexamethasone for 12 days. Afterwards, she returned three days after her discharge with a complaint of pre-orbital cellulitis, unilateral facial numbness and decreased visual acuity. Therefore, after primary diagnostic imaging, she was regarded as a candidate for invasive surgical intervention and was consequently treated with a combination of liposomal amphotericin B, radical recurrent surgery and posaconazole. CONCLUSION It is very important to consider patients who are in the pre-diabetic state or possibly immunocompromised before prescribing steroids. The patients should be examined for invasive fungal infections in post-discharge period.
Collapse
Affiliation(s)
- Masoud Mardani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolreza Babamahmoodi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
17
|
Philip AC, Madan P, Sharma S, Das S. Utility of
MGG
and Papanicolaou stained smears in the detection of Mucormycosis in nasal swab/scraping/biopsy samples of
COVID
19 patients. Diagn Cytopathol 2021; 50:93-98. [PMID: 34967146 PMCID: PMC9015538 DOI: 10.1002/dc.24924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/27/2021] [Accepted: 12/17/2021] [Indexed: 01/08/2023]
Abstract
Background Methods Results Conclusion
Collapse
Affiliation(s)
- Ashish C. Philip
- Department of Pathology University College of Medical Sciences, University of Delhi Delhi India
| | - Prarthna Madan
- Department of Pathology University College of Medical Sciences, University of Delhi Delhi India
| | - Sonal Sharma
- Department of Pathology University College of Medical Sciences, University of Delhi Delhi India
| | - Shukla Das
- Department of Microbiology University College of Medical Sciences, University of Delhi Delhi India
| |
Collapse
|
18
|
Heydarifard Z, Safaei M, Zadheidar S, Ehsan S, Shafiei‐Jandaghi NZ. Mucormycosis infection in severe COVID-19 patient with multiple underlying health conditions. Clin Case Rep 2021; 9:e05009. [PMID: 34745621 PMCID: PMC8552078 DOI: 10.1002/ccr3.5009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/03/2021] [Accepted: 10/09/2021] [Indexed: 01/14/2023] Open
Abstract
Patients with underlying health conditions are vulnerable to invasive fungal infection following COVID-19. It seems that uncontrolled diabetes mellitus makes patients susceptible to both severe COVID-19 and mucormycosis.
Collapse
Affiliation(s)
- Zahra Heydarifard
- Virology DepartmentSchool of Public HealthTehran University of Medical SciencesTehranIran
| | - Moslem Safaei
- Department of PharmacySchool of PharmacyShahid Sadoughi University of Medical ScienceYazdIran
| | - Sevrin Zadheidar
- Virology DepartmentSchool of Public HealthTehran University of Medical SciencesTehranIran
| | - Soroush Ehsan
- Department of NeurologyValiasr Naja HospitalShahid Beheshti University of Medical SciencesTehranIran
| | | |
Collapse
|
19
|
Barman Roy D, Gupta V, Biswas A, Verma M. Early Surgical Intervention Followed by Antifungals in Rhino-Orbital Mucormycosis in Patients With COVID-19 Favors Clinical Outcome: A Case Series. Cureus 2021; 13:e17178. [PMID: 34548980 PMCID: PMC8437210 DOI: 10.7759/cureus.17178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 01/18/2023] Open
Abstract
Mucormycosis is an invasive fungal infection occurring in patients with or without preexisting medical illnesses. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal coinfections among some COVID-19 patients with preexisting comorbid illnesses such as diabetes and hypertension, with mucormycosis being one of them. The management of this dreaded fungal infection demands early and prompt surgical intervention to thoroughly remove the infected tissue and necrotic material to reduce the tissue burden of this invasive organism. This should be accompanied by expeditious initiation of amphotericin B along with supportive therapy. Here we present five cases of rhino-orbital mucormycosis in patients with COVID-19, all of whom presented with orbital and facial swelling (three had symptoms of impending blindness) under the backdrop of COVID-19 symptoms in the form of intermittent fever and slight dyspnea. Our treatment strategy comprised an expeditious use of early surgical intervention and amphotericin B along with the control of cytokine storm and hyperglycemia. This treatment strategy eventually resulted in an improved clinical outcome.
Collapse
Affiliation(s)
| | - Vandana Gupta
- Dentistry, All India Institute of Medical Sciences, New Delhi, IND
| | - Ashutosh Biswas
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Mansi Verma
- Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, IND
| |
Collapse
|
20
|
Dubey S, Mukherjee D, Sarkar P, Mukhopadhyay P, Barman D, Bandopadhyay M, Pandit A, Sengupta A, Das S, Ghosh S, Adhikari S, Biswas PS, Pal P, Roy H, Patra N, Das A, Sinha P, Mondal MK, Shrivastava SR, Bhattacharya K, Mukhopadhyay M, Ahmed K, Halder TK, Saha M, Ahmed K, Maity S, Mandal A, Chatterjee D, Saha S, Chunakar A, Saha A, Ray BK. COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum. Diabetes Metab Syndr 2021; 15:102267. [PMID: 34509790 PMCID: PMC8407938 DOI: 10.1016/j.dsx.2021.102267] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 07/28/2021] [Accepted: 08/30/2021] [Indexed: 12/30/2022]
Abstract
AIMS 1: Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2: Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. METHODS Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. RESULTS Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. CONCLUSIONS New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.
Collapse
|
21
|
Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the "black fungus". Clin Radiol 2021; 76:812-819. [PMID: 34364672 PMCID: PMC8316064 DOI: 10.1016/j.crad.2021.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/20/2021] [Indexed: 12/26/2022]
Abstract
A subset of diabetic COVID-19 patients treated with steroids, oxygen, and/or prolonged intensive care admission develop rhino-orbito-cerebral mucormycosis. Radiologists must have a high index of suspicion for early diagnosis, which prompts immediate institution of antifungal therapy that limits morbidity and mortality. Assessment of disease extent by imaging is crucial for planning surgical debridement. Complete debridement of necrotic tissue improves survival. Imaging features reflect the angioinvasive behaviour of fungal hyphae from the Mucoraceae family, which cause necrotising vasculitis and thrombosis resulting in extensive tissue infarction. Contrast-enhanced magnetic resonance imaging (MRI) is the imaging technique of choice. The classic “black turbinate” on contrast-enhanced imaging represents localised invasive fungal rhinosinusitis (IFRS). A striking radiological feature of disseminated craniofacial disease is non-enhancing devitalised and necrotic soft tissue at the orbits and central skull base. Sinonasal and extrasinonasal non-enhancing lesions in IFRS are secondary to coagulative necrosis induced by fungal elements. Multicompartmental and extrasinonasal tissue infarction is possible without overt bone involvement and caused by the propensity of fungal elements to disseminate from the nasal cavity via perineural and perivascular routes. Fungal vasculitis can result in internal carotid artery occlusion and cerebral infarction. Remnant non-enhancing lesions after surgical debridement portend a poor prognosis. Assessment for the non-enhancing MRI lesion is crucial, as it is a sole independent prognostic factor for IFRS-specific mortality. In this review, we describe common and uncommon imaging presentations of biopsy-proven rhino-orbito-cerebral mucormycosis in a cohort of nearly 40 COVID-19 patients.
Collapse
|
22
|
Kumari A, Rao NP, Patnaik U, Malik V, Tevatia MS, Thakur S, Jaydevan J, Saxena P. Management outcomes of mucormycosis in COVID-19 patients: A preliminary report from a tertiary care hospital. Med J Armed Forces India 2021; 77:S289-S295. [PMID: 34334896 PMCID: PMC8313063 DOI: 10.1016/j.mjafi.2021.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) continues to be a significant health problem worldwide. The unprecedented surge of mucormycosis in patients with COVID-19 is a new emerging challenge. Although a few studies documenting high incidence of mucormycosis in COVID -19 patients have recently emerged in literature, data pertaining to treatment outcomes in such cohorts is lacking. Here, we report our experience in management of mucormycosis in COVID-19 patients at our tertiary care centre. Method The clinical, imaging, histopathological and treatment data of 20 patients with mucormycosis (in setting of COVID-19) was analysed. Results 35% and 65 % of cases developed mucormycosis in setting of active and recovered COVID-19 infections respectively. Diabetes mellitus was documented in 80% cases, with 55% demonstrating HbA1c >10%. Steroid was administered in 80% during COVID-19 illness. Imaging demonstrated paranasal sinus (PNS), orbital and intracranial extension in 100%, 55% and 20% patients respectively. All received amphotericin and underwent endoscopic debridement, 20% underwent orbital decompression and 5% maxillectomy with orbital exenteration. 6/20(30%) patients died (4 with rhino-orbito-cerebral disease, 1 with extensive orbito-maxillary involvement and 1 sino-nasal disease). All 6 patients received steroids and documented poor glycaemic control. Conclusion The strong association of hyperglycemia and steroid intake with mucormycosis in COVID-19 cases warrants judicious use of corticosteroids and optimal glycaemic control. Our study highlights that good clinical outcome can be achieved in invasive mucormycosis provided prompt treatment is instituted with aggressive surgical debridement and antifungal medication.
Collapse
Affiliation(s)
- Abha Kumari
- Classified Specialist (ENT), Command Hospital (Southern Command), Pune, India
| | | | - Uma Patnaik
- Senior Advisor & Head (ENT), Command Hospital (Southern Command), Pune, India
| | - Virender Malik
- Classified Specialist (Imaging & Intervention Radiology), Army Institute of Cardio Thoraicic Sciences, Pune, India
| | | | - Shivali Thakur
- Graded Specialist (ENT), Command Hospital (Southern Command), Pune, India
| | - Jijesh Jaydevan
- Resident (ENT), Command Hospital (Southern Command), Pune, India
| | - Pavitra Saxena
- Resident (ENT), Command Hospital (Southern Command), Pune, India
| |
Collapse
|
23
|
Bayram N, Ozsaygılı C, Sav H, Tekin Y, Gundogan M, Pangal E, Cicek A, Özcan İ. Susceptibility of severe COVID-19 patients to rhino-orbital mucormycosis fungal infection in different clinical manifestations. Jpn J Ophthalmol 2021; 65:515-525. [PMID: 34057620 PMCID: PMC8165350 DOI: 10.1007/s10384-021-00845-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/06/2021] [Indexed: 12/28/2022]
Abstract
Purpose To present the different clinical manifestations of rhino-orbital mucormycosis (ROM) co-infection in severe COVID-19 patients. Study design Prospective observational clinical study Methods Among 32,814 patients hospitalized with the diagnosis of COVID-19 between March 2020 and December 2020 in our center, eleven microbiologically confirmed ROM co-infection cases in severe COVID-19 patients were evaluated. Results There were nine men and two women with a mean age of 73.1 ± 7.7 years. Eight patients had uncontrolled type 2 diabetes with a mean diagnosis duration of 12.1 ± 4.4 years. All patients had COVID-19-associated acute respiratory distress syndrome and received corticosteroids. The mean time interval between COVID-19 diagnosis and ROM diagnosis was 14.4 ± 4.3 days. Seven patients (63.6%) had orbital apex syndrome, and four patients (36.4%) presented with orbital cellulitis. Endophthalmitis was detected in 54.5% of patients, and two of these patients developed retinoschisis. CT scan/MRI revealed sino-orbital involvement in all patients, and three of these had cerebral involvement at initial presentation. All patients received intravenous and retrobulbar liposomal amphotericin B and had undergone radical debridement of involved sinuses. Intravitreal liposomal amphotericin B injected in patients with endophthalmitis. Despite all measures, 63.6% of patients expired. Conclusions Severe COVID-19 is associated with a significant incidence of ROM with higher mortality rates due to immune dysregulation and the widespread use of steroids. Physicians should be aware of the possibility of this infection in patients with COVID-19. An aggressive multidisciplinary approach can help to reduce mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10384-021-00845-5.
Collapse
Affiliation(s)
- Nurettin Bayram
- Department of Ophthalmology, Kayseri City Training and Research Hospital, University of Health Science, 38080, Kayseri, Turkey.
| | - Cemal Ozsaygılı
- Department of Ophthalmology, Kayseri City Training and Research Hospital, University of Health Science, 38080, Kayseri, Turkey
| | - Hafize Sav
- Department of Mycology, Kayseri City Training and Research Hospital, University of Health Science, Kayseri, Turkey
| | - Yucel Tekin
- Department of Pathology, Kayseri City Training and Research Hospital, University of Health Science, Kayseri, Turkey
| | - Medine Gundogan
- Department of Ophthalmology, Kayseri City Training and Research Hospital, University of Health Science, 38080, Kayseri, Turkey
| | - Emine Pangal
- Department of Ophthalmology, Kayseri City Training and Research Hospital, University of Health Science, 38080, Kayseri, Turkey
| | - Ayse Cicek
- Department of Ophthalmology, Kayseri City Training and Research Hospital, University of Health Science, 38080, Kayseri, Turkey
| | - İbrahim Özcan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kayseri City Training and Research Hospital, University of Health Science, Kayseri, Turkey
| |
Collapse
|
24
|
Maini A, Tomar G, Khanna D, Kini Y, Mehta H, Bhagyasree V. Sino-orbital mucormycosis in a COVID-19 patient: A case report. Int J Surg Case Rep 2021; 82:105957. [PMID: 33964720 PMCID: PMC8093005 DOI: 10.1016/j.ijscr.2021.105957] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION We report a case of post COVID-19 Sino-orbital Mucormycosis infection caused by Rhizopus oryzae and its management. PRESENTATION OF CASE The patient was diagnosed with COVID-19 and treated according to the persisting protocols. Following recovery, on the 18th day, the patient developed chemosis and pain in the left eye. A diagnosis of mucormycosis was established after Magnetic Resonance Imaging (MRI) and Functional Endoscopic Sinus Surgery (FESS). Initially, conservative management with intravenous (IV) Fluconazole & Amphotericin B was done and later on with surgical debridement. The patient recovered with minimal residual deformity. DISCUSSION Mucormycosis generally develops secondary to immunosuppression or debilitating diseases. In Head and Neck cases, the mold usually gains entry through the respiratory tract involving the nose and sinuses, with possible further progression into the orbital and intracranial structures. Hence, an early diagnosis and intervention is required for a good prognosis, decreasing the morbidity. This can be achieved on the basis of clinical picture and direct smears. CONCLUSION Research needs to be carried out in COVID-19 patients for better prevention and management of opportunistic infections in order to reduce its incidence and morbidity. Prophylactic treatment protocols need to be established, along with rational use of corticosteroids.
Collapse
Affiliation(s)
- Aastha Maini
- Department Of Oral and Maxillofacial Surgery, D. Y. Patil University, Sector 7 Nerul, Navi Mumbai 400706, India
| | - Gaurav Tomar
- Department Of Oral and Maxillofacial Surgery, D. Y. Patil University, Sector 7 Nerul, Navi Mumbai 400706, India.
| | - Deepak Khanna
- Unit Head - Head and Neck Oncology & Associate Professor Oral and Maxillofacial Surgery, School of Medicine D. Y. Patil University, Sector 7 Nerul, Navi Mumbai, India
| | - Yogesh Kini
- Department Of Oral and Maxillofacial Surgery, D. Y. Patil University, Sector 7 Nerul, Navi Mumbai 400706, India
| | - Hardik Mehta
- Department Of Oral and Maxillofacial Surgery, D. Y. Patil University, Sector 7 Nerul, Navi Mumbai 400706, India
| | - V Bhagyasree
- Department Of Oral and Maxillofacial Surgery, D. Y. Patil University, Sector 7 Nerul, Navi Mumbai 400706, India
| |
Collapse
|
25
|
Beiglboeck FM, Theofilou NE, Fuchs MD, Wiesli MG, Leiggener C, Igelbrink S, Augello M. Managing mucormycosis in diabetic patients: A case report with critical review of the literature. Oral Dis 2021; 28:568-576. [PMID: 33583133 DOI: 10.1111/odi.13802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/23/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Rhino-orbito-cerebral mucormycosis (ROCM) is a rare and potentially fatal invasive fungal infection which usually occurs in diabetic and other immunocompromised patients. This infection is associated with high morbidity and mortality rates. Prompt diagnosis and rapid aggressive surgical debridement and antimycotic therapy are essential for the patient's survival. Herein, we reviewed the localization and treatment strategies in patients with ROCM and diabetes as an underlying condition. Furthermore, we report one case of ROCM in our department. MATERIALS AND METHODS From 117 identified studies published in PubMed, 14 publications-containing data from 54 patients-were included. All patients were diagnosed clinically and by histopathological and/or bacteriological analysis for ROCM caused by the order Mucorales. CONCLUSION Uncontrolled diabetes mellitus is one of the main risk factors for ROCM. A successful management of ROCM requires an early diagnosis, a prompt systemic antifungal therapy, and a rapid aggressive surgical debridement including exploration of the pterygopalatine fossa. An orbital exenteration may be necessary.
Collapse
Affiliation(s)
- Fabian M Beiglboeck
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland.,Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Department of Oral- and Maxillofacial Surgery, University Hospital Muenster, Münster, Deutschland
| | - Nantia E Theofilou
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Matthias D Fuchs
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Matthias G Wiesli
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Christoph Leiggener
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Igelbrink
- Department of Oral- and Maxillofacial Surgery, University Hospital Muenster, Münster, Deutschland
| | - Marcello Augello
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
26
|
Chegini Z, Didehdar M, Khoshbayan A, Rajaeih S, Salehi M, Shariati A. Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series. Mycoses 2020; 63:1264-1282. [PMID: 32965744 DOI: 10.1111/myc.13187] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with diabetes are known as an important high-risk group for cerebral mucormycosis (CM). METHOD We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020. RESULTS Forty-five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7% and 38.8% of individual cases and case series, respectively. Mortality ranged from 0% to 100% in the case series. The overall mortality in the individual cases was 46.3%, and 64.2% of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3%), headache (44.4%), loss of vision (35.5%) and ophthalmoplegia (35.5%) were the most frequently reported clinical symptoms. In all patients except 4 (91.1%), CM was treated surgically; however, in many cases (42%), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid-based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low-income and health-challenged countries. CONCLUSION Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low-income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries.
Collapse
Affiliation(s)
- Zahra Chegini
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Amin Khoshbayan
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Rajaeih
- ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aref Shariati
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|