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Abdulbaki H, Callander JK, Fastenberg JH, Russell MS, Vagefi MR, Kersten RC, Loftus PA. Transcutaneous Retrobulbar Amphotericin B Injection for Invasive Fungal Sinusitis with Orbital Involvement: A Systematic Review. Am J Rhinol Allergy 2024:19458924241254422. [PMID: 38772559 DOI: 10.1177/19458924241254422] [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: 05/23/2024]
Abstract
BACKGROUND Orbital involvement of invasive fungal sinusitis (IFS) is an ominous prognostic marker that should prompt rapid intervention. Transcutaneous retrobulbar administration of amphotericin B (TRAMB) is an off-label adjunctive treatment that can increase drug penetrance into diseased orbital tissue. To date, there is a lack of consensus regarding the use of TRAMB for treatment of IFS with orbital involvement. OBJECTIVE This systematic review aims to synthesize the indications, efficacy, and potential complications of TRAMB. METHODS PubMed, EMBASE, and Web of Science databases were probed for systematic review. Article search was conducted through June 2023 using the keywords "invasive fungal sinusitis," "invasive fungal rhinosinusitis," "rhino-orbital mucormycosis," "rhinosinusitis," "orbital," "retrobulbar," and "amphotericin." RESULTS In suitable cases as determined by radiologic and clinical evaluation, TRAMB administration has the potential to improve orbital salvage rates and improve versus stabilize visual acuity. Treatment complications are more likely with deoxycholate than with liposomal amphotericin formulations. The existing literature describing use of TRAMB is limited due to its retrospective nature, but the increase in IFS cases since 2020 due to the COVID pandemic has broadened the literature. CONCLUSIONS TRAMB is an effective adjunctive treatment in IFS with mild-to-moderate orbital involvement when used in combination with standard of care debridement, systemic antifungal therapy, and immunosuppression reversal. Prospective longitudinal studies and multi-institutional randomized trials are necessary to determine the definitive utility of TRAMB.
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Affiliation(s)
- Hasan Abdulbaki
- School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Judd H Fastenberg
- Department of Otolaryngology-Head and Neck Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA
| | - Matthew S Russell
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - M Reza Vagefi
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - Robert C Kersten
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Patricia A Loftus
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
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Dallalzadeh LO, Ediriwickrema LS, Fung SE, Men CJ, Kossler AL, Kupcha AC, Mawn LA, Burkat CN, van Landingham SW, Conger JR, Simmons B, Pham C, Akella SS, Setabutr P, Ho T, Couch SM, Kim JS, Demirci H, Korn BS, Kikkawa DO, Liu CY. Transcutaneous retrobulbar amphotericin B for rhino-orbital-cerebral mucormycosis: a multi-center retrospective comparative study. Orbit 2024; 43:41-48. [PMID: 36880205 DOI: 10.1080/01676830.2023.2186435] [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] [Received: 10/14/2022] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE To assess whether transcutaneous retrobulbar amphotericin B injections (TRAMB) reduce exenteration rate without increasing mortality in rhino-orbital-cerebral mucormycosis (ROCM). METHODS In this retrospective case-control study, 46 patients (51 eyes) with biopsy-proven ROCM were evaluated at 9 tertiary care institutions from 1998 to 2021. Patients were stratified by radiographic evidence of local orbital versus extensive involvement at presentation. Extensive involvement was defined by MRI or CT evidence of abnormal or loss of contrast enhancement of the orbital apex with or without cavernous sinus, bilateral orbital, or intracranial extension. Cases (+TRAMB) received TRAMB as adjunctive therapy while controls (-TRAMB) did not. Patient survival, globe survival, and vision/motility loss were compared between +TRAMB and -TRAMB groups. A generalized linear mixed effects model including demographic and clinical covariates was used to evaluate the impact of TRAMB on orbital exenteration and disease-specific mortality. RESULTS Among eyes with local orbital involvement, exenteration was significantly lower in the +TRAMB group (1/8) versus -TRAMB (8/14) (p = 0.04). No significant difference in mortality was observed between the ±TRAMB groups. Among eyes with extensive involvement, there was no significant difference in exenteration or mortality rates between the ±TRAMB groups. Across all eyes, the number of TRAMB injections correlated with a statistically significant decreased rate of exenteration (p = 0.048); there was no correlation with mortality. CONCLUSIONS Patients with ROCM with local orbital involvement treated with adjunctive TRAMB demonstrated a lower exenteration rate and no increased risk of mortality. For extensive involvement, adjunctive TRAMB does not improve or worsen these outcomes.
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Affiliation(s)
- Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
| | - Lilangi S Ediriwickrema
- Division of Ophthalmic Plastic and Reconstructive Surgery, Gavin Herbert Eye Institute, UC Irvine, Irvine, California, USA
| | - Sammie E Fung
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
| | - Clara J Men
- Division of Oculoplastic and Orbital Surgery, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Andrea L Kossler
- Division of Oculoplastic and Orbital Surgery, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anna C Kupcha
- Division of Oculoplastics and Orbital Disease, Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - Louise A Mawn
- Division of Oculoplastics and Orbital Disease, Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - Cat N Burkat
- Oculoplastic, Orbital, & Cosmetic Facial Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Suzanne W van Landingham
- Oculoplastic, Orbital, & Cosmetic Facial Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Jordan R Conger
- Division of Ophthalmic Plastic and Reconstructive Surgery, Gavin Herbert Eye Institute, UC Irvine, Irvine, California, USA
| | - Brittany Simmons
- Division of Oculoplastic, Orbit, and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Chau Pham
- Division of Oculoplastic, Orbit, and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Sruti S Akella
- Oculoplastic and Reconstructive Surgery Service, Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, USA
| | - Pete Setabutr
- Oculoplastic and Reconstructive Surgery Service, Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, USA
| | - Tiffany Ho
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Steven M Couch
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jane S Kim
- Division of Eye Plastic, Orbital and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Hakan Demirci
- Division of Eye Plastic, Orbital and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, USA
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
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Raj A, Singh P, Sadhukhan K, Chandra B, Kranti B, Kumar S, Sinha U, Kokkayil P, Bhadani PP, Sinha P, Sanepalli S, Tiwari P, Nanda J. Survival benefit of exenteration in COVID-19-associated rhino-orbital mucormycosis. Indian J Ophthalmol 2024; 72:190-194. [PMID: 38099361 PMCID: PMC10941941 DOI: 10.4103/ijo.ijo_2543_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE There has been a sudden increase in the number of rhino-orbital mucormycosis cases, primarily affecting patients recovering from COVID-19 infection. The local health authorities have declared the current situation an epidemic. In this study, we assess the role of exenteration in preventing disease progression and improving survival in patients with rhino-orbital mucormycosis. METHODS The patients undergoing exenteration were grouped into the exenteration arm and those denying exenteration were grouped into the nonexenteration arm. The patients were followed at 1 month and 3 months. The 6-month survival data were collected telephonically. Continuous data were presented as Mean ± SD/Median (IQR) depending on the normality distribution of data, whereas the frequency with percentages was used to present the categorical variables. Kaplan-Meier survival curves were created to estimate the difference in survival of patients with exenteration in rhino-orbital mucormycosis versus those without exenteration. RESULTS A total of 14 patients were recruited for our study based on the inclusion and exclusion criteria. All the patients were qualified for exenteration; however, only eight patients underwent exenteration and six patients did not consent to exenteration. At the end of 3 months in the exenteration group, four (50%) patients died. Two patients died within a week of exenteration, whereas two patients died after 2 weeks of exenteration. The deaths in the first week were attributed to septic shock and the deaths happening beyond 2 weeks were attributed to severe meningitis. The Kaplan-Meier survival analysis showed the cumulative probability of being alive at 1 month in the exenteration arm to be 85%, and it decreased to 67% by 53 days and subsequently remained stable until the end of 3 months. CONCLUSION The Kaplan-Meier survival analysis did not show a survival benefit of exenteration at 3 months and 6 months in COVID-associated rhino-orbital mucormycosis.
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Affiliation(s)
- Amit Raj
- Department of Ophthalmology, AIIMS, Patna, Bihar, India
| | | | | | | | - Bhavana Kranti
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Subhash Kumar
- Department of Radiodiagnosis, AIIMS, Patna, Bihar, India
| | - Upasna Sinha
- Department of Radiodiagnosis, AIIMS, Patna, Bihar, India
| | | | | | - Prerna Sinha
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Sravani Sanepalli
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Pragati Tiwari
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Jayadev Nanda
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
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Farooq S, Khan NA, Singh A, Khan A, Sharma P, Meena R, Jakhar A, Kumar M, Kochar A. Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe. Cureus 2023; 15:e41010. [PMID: 37519583 PMCID: PMC10372466 DOI: 10.7759/cureus.41010] [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: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Mucormycosis (black fungus) is a rare opportunistic fungal infection commonly affecting immunocompromised individuals. There has been a surge in the number of these cases during the second wave of the coronavirus disease 2019 (COVID-19) in India. Mucormycosis has been reported to occur within a week or a few weeks post-recovery from COVID-19. The most common clinical manifestation of mucormycosis is rhino-orbital-cerebral mucormycosis (ROCM). At our tertiary care center, we initiated a prospective study to identify risk factors, study ocular manifestations, and explore medical and surgical management of orbital mucormycosis patients in the post-COVID-19 era. Material and methods This is a detailed description of a prospective observational hospital-based study. The study included 148 patients who presented with ROCM. A detailed history was taken regarding the complaint, duration, and associated risk factors. Systemic, local, and complete ophthalmic examinations were done that included assessment of extraocular movements, visual acuity, slit-lamp examination, and fundus examination. All data were recorded separately for each patient in a pre-decided proforma. Result The study group consisted of 148 patients. In our study, the highest association was with COVID-19-positive status (68.24%), out of which 57 (56.43%) were on oxygen support. Diabetes mellitus contributed next to COVID-19 with 86 (58.10%) patients with a positive history of diabetes. Seventy-one (47.97%) patients were on steroids, out of which 68 (67.32%) were COVID-19-positive and the rest (23%) were on steroids due to various systemic reasons. Rhinomaxillary involvement was present (51%). Out of 63 patients with orbital involvement, 16 (25.39%) presented bilaterally and 47 showed unilateral orbital involvement more on the right side (42.85%). The predominant location of orbital involvement was the orbital apex. The most common symptom seen in our study was nasal discharge (86.5%), and ophthalmoplegia was the most common sign. Conclusion Corticosteroids should be used with caution to prevent negative impact and potential ROCM. Good glycemic and metabolic control is crucial for treatment. Management of mucormycosis involves surgical debridement, antifungal agents, and retrobulbar amphotericin B injections. Early diagnosis and aggressive treatment are essential for success. Orbital exenteration may be necessary for advanced stages, while conservative approaches may work for earlier stages. Patient counseling is needed for cosmetic rehabilitation. A multidisciplinary approach involving various specialists is necessary.
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Affiliation(s)
- Shaheen Farooq
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Nabab A Khan
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Ajeet Singh
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Arif Khan
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Preeti Sharma
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Ritu Meena
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Ankita Jakhar
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Mukesh Kumar
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
| | - Anju Kochar
- Ophthalmology, Sardar Patel Medical College, Prince Bijay Singh Memorial (PBM) Hospital, Bikaner, IND
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Keshri A, Mathialagan A, Aishwarya A, Ravisankar, Bhuskute G, Kanaujia V, Singh AK, Singh RK, Dhiman RK, Agarwal R. Is mucormycosis the end? A comprehensive management of orbit in COVID associated rhino-orbital-cerebral mucormycosis: preserving the salvageable. Eur Arch Otorhinolaryngol 2023; 280:819-827. [PMID: 36053359 PMCID: PMC9438883 DOI: 10.1007/s00405-022-07620-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/16/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Rhino-orbital-cerebral mucor mycosis (ROCM) is a relatively rare opportunistic infection caused by the Mucorales species. While ROCM suggests involvement of the paranasal sinuses, orbit and brain ROM (rhino-orbital-Mucormycosis) stands for the fungal invasion in sinuses and orbit sans cerebral involvement. In India with the outbreak of the second COVID wave and the delta variant of the virus, there has been a steep increase in this opportunistic fulminant fungal infection, named COVID-associated Mucor mycosis (CAM). The most critical question in orbital management is when to go ahead with an exenteration. Our study aims to design a pertinent minimal invasive surgical protocol for surgeons to manage such cases based on our surgical experience and mitigate the need for exenteration and save the eyes wherever possible. METHODS The study is a retrospective analysis of patients of ROM with and without brain involvement, who underwent minimal surgical management between March 2021 to March 2022 along with their follow-up. RESULTS There were 184 eyes of 148 patients diagnosed with CAM. The mean age was 51.7 years with a male predominance of 103 (70%). All patients developed ROM following the COVID-19 infection and the duration between diagnosis of COVID-19 and ROM was 36 ± 23 days. 18 cases (12%) were bilateral. 76 eyes (41%) had no vision at the presentation. Imaging revealed paranasal sinus involvement (100%), orbital apex involvement (61%), cavernous sinus involvement (53%), and central nervous system (CNS) involvement (47%). All the patients (100%) were treated with systemic Liposomal amphotericin-B and sinus debridement. Endoscopic debridement of the orbital disease was performed in 45 (30.4%) cases, 15(8.1%) eyes underwent exenteration and were later rehabilitated with a customized ocular prosthesis, 103 (56%) eyes underwent transcutaneous retrobulbar amphotericin-B. At a mean follow-up of 13.1 months; the complete resolution was seen in 25 (17%) cases, the residual stable lesion was seen in 77(52%) of the cases and new lesions were developed in 13(9%) of the cases. Mortality was seen in 33 (22%) patients and all of them had CNS involvement. CONCLUSIONS Systemic and protocol-based management can save the life and salvage the eyes.
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Affiliation(s)
- Amit Keshri
- Department of Neurosurgery (Neuro-Otology Unit), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Arulalan Mathialagan
- Department of Neurosurgery (Neuro-Otology Unit), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Ankita Aishwarya
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Ravisankar
- Department of Neurosurgery (Neuro-Otology Unit), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Govind Bhuskute
- Department of Neurosurgery (Neuro-Otology Unit), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Vikas Kanaujia
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - A. K. Singh
- Council of Scientific and Industrial Research, New Delhi, India
| | - R. K. Singh
- Department of Emergency Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - R. K. Dhiman
- Department of Hepatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
| | - Rachna Agarwal
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow, 226014 India
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Solanki NM, Solanki RN, Madaliya AV, Jasoliya RH, Upadhyay DT. COVID-19-associated mucormycosis: an update of anesthetic management. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2022. [PMCID: PMC8830946 DOI: 10.1186/s42077-022-00216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Mucormycosis is uncommon, progressive fungal infection with mortality rate on higher side. The anesthetic management of surgical debridement in mucormycosis is challenging.
We evaluated the anesthetic management of mucormycosis patients associated with problems of airway management, predisposing factors, and adverse effect of antifungal therapy who underwent surgical resection of necrotized tissues.
Results
Fifty-six patients presented with uncontrolled diabetes mellitus. All patients had history of COVID-19 infection and received steroid during treatment. Nasal endoscopic debridement was done in 43 patients, total maxillectomy in 14 patients. Temporalis flap was needed in five patients, and orbital exenteration was required in three patients. Central venous catheter was inserted in 17 patients, and invasive arterial monitoring was done in ten patients. All patients administered lyophilized amphotericin B (deoxycholate) in combination with surgical debridement.
Thirteen patients were shifted to ICU for further management and continuous hemodynamic monitoring. Fifteen patients were expired, and the mortality rate was 26.31%.
Conclusions
Challenges include difficult intubation and renal function impairment due to prolonged antifungal therapy. Postoperative ICU management is important in mucormycosis patients due to comorbidities and rapid progressive infection after surgery.
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Shakrawal J, Sharma V, Goyal A, Kumar D, Meena S, Tiwari S, Jain V, Elhence P, Soni K, Choudhury B, Bhatnagar K, Garg MK, Misra S. Outcomes of transcutaneous retrobulbar Amphotericin B (TRAMB) as an adjuvant therapy for rhino-orbital-cerebral mucormycosis (ROCM) following COVID-19. Int Ophthalmol 2022; 43:1919-1926. [DOI: 10.1007/s10792-022-02591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022]
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Ohadi MAD, Banihashemi G, Dilmaghani NA, Shamsi MA, Sharifi G. COVID-19-related rhino-orbital-cerebral mucormycosis: Neurological manifestation and related risk factors in two cases. Clin Case Rep 2022; 10:e6352. [PMID: 36276900 PMCID: PMC9582679 DOI: 10.1002/ccr3.6352] [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: 05/11/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
Abstract
Mucormycosis is an opportunistic infection that has become a serious concern as a result of the immunosuppressive drugs used during COVID‐19. In this report, we describe two cases of rhino‐orbital‐cerebral mucormycosis with neurological presentation and ophthalmologic problems accompanied by a history of COVID‐19 and diabetes.
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Affiliation(s)
- Mohammad Amin Dabbagh Ohadi
- Skull Base Research Center, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
- Department of Neurology, Sina HospitalTehran University of Medical SciencesTehranIran
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Gelareh Banihashemi
- Skull Base Research Center, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
- Department of Neurology, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Nader Akbari Dilmaghani
- Hearing Disorders Research Center, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
- Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Educational Hospital, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Ali Shamsi
- Skull Base Research Center, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
- Department of Neurological Surgery, Loghman Hakim Hospital, Faculty of MedicineShahid Beheshti University of Medical ScienceTehranIran
| | - Guive Sharifi
- Skull Base Research Center, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
- Professor of Neurosurgery, Skull Base Research Center, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
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Retrobulbar Amphotericin B Injection in Curbing the Progression of COVID Associated Rhino-orbital Cerebral Mucormycosis: A Retrospective Case Series. Indian J Otolaryngol Head Neck Surg 2022; 74:3352-3358. [PMID: 36246726 PMCID: PMC9547996 DOI: 10.1007/s12070-022-03199-7] [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: 01/31/2022] [Accepted: 09/23/2022] [Indexed: 10/30/2022] Open
Abstract
Purpose To assess whether transcutaneous retrobulbar Amphotericin B (TRAMB) injection can halt disease progression and reduce the requirement of exenteration in post-COVID 19 Rhino-orbital cerebral Mucormycosis (ROCM)) with limited orbital disease. Methods Retrospective series from a single center included 22 patients with KOH proved post-COVID 19 ROCM with radiographic evidence of limited orbital involvement were evaluated from May 2021 to October 2021. TRAMB was given along with systemic intravenous Amphotericin B injection and sinus debridement. Demographic profile, clinical data, operative notes, blood and radiological investigations were evaluated. The primary outcome was to assess the halt in the progression of orbital disease. The primary outcome measure was to assess the halt of the disease progression and the secondary outcome was improvement in the clinical signs and symptoms. Results The mean age was 50.36 ± 9.72 years and 77.3% were men. The Stagewise distribution was twelve (54.5%) patients in stage 3a, four (18.2%) patients in stage 3b, four (18.2%) in stage 3c, one (4.5%) patient in stage 3d and one (4.5%) had stage 4 disease. Improvement in lid edema and conjunctival chemosis were noticed and it was statistically significant (p value < 0.01), similarly visual acuity and ocular motility showed significant improvements (p value 0.04 and < 0.01 respectively). 1 patient died and 1 patient required exenteration later. Twenty patients showed halting of orbital disease after TRAMB injection. Conclusion TRAMB can be an alternative adjuvant therapeutic option to preserve the globe in patients with limited orbital disease but not at all replacement for exenteration.
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10
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Khare P, Chaurasia Y, Bhatnagar S. Exploring the globe salvaging treatment options in patients of COVID-19-associated mucormycosis with orbital involvement. Indian J Ophthalmol 2022; 70:3638-3642. [PMID: 36190063 PMCID: PMC9789804 DOI: 10.4103/ijo.ijo_938_22] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose To explore the various globe salvaging treatment strategies for patients with coronavirus disease 2019-associated mucormycosis (CAM). Methods: This was a prospective interventional analytical study conducted at a Medical College in rural India. A total of 84 patients of CAM admitted between May 2021 and August 2021 were enrolled for the study. Patients with histologically proven CAM with clinical and/or radiological evidence of orbital involvement were divided into three treatment categories based on the site and extent of the lesion. Re-assessment was performed after 7 days. For patients who worsened with the primary approach, orbital exenteration was considered based on a Sion Hospital Scoring System. A novel approach to intra-orbital anti-fungal therapy, site-centered peri-bulbar injection of amphotericin B (SCPeriAmB), was also explored. All the patients were followed up for at least 3 months. Convenience sampling with descriptive statistics was used. Results Six patients had to finally undergo exenteration by the end of the study period. The rest of the patients were reported to be stable or improved. No mortalities were reported on delaying the exenteration. No adverse events were noted in patients who were given SCPeriAmB. Conclusion Globe salvaging treatment options should be advocated as a primary approach in patients with CAM. Site-centered peri-bulbar injections can be considered as an approach for delivering intra-orbital anti-fungal therapy in selected patients.
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Affiliation(s)
- Praveen Khare
- Department of Ophthalmology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
| | - Yogita Chaurasia
- Department of Ophthalmology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India,Correspondence to: Dr. Yogita Chaurasia, Shanti Nagar Colony, Sagar Road, Chhatarpur 471001, Madhya Pradesh, India. E-mail:
| | - Shweta Bhatnagar
- Department of Dentistry, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
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11
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Sharifi A, Akbari Z, Shafie’ei M, Nasiri N, Sharifi M, Shafiei M, Zand A. Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review. Ophthalmic Plast Reconstr Surg 2022; 38:425-432. [PMID: 35943425 PMCID: PMC9451608 DOI: 10.1097/iop.0000000000002256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Following COVID-19 infection a rising count of rhino-orbito-cerebral mucormycosis is observed, requiring orbital exenteration, a disabling lifetime affecting surgery. One of the potential interventions for globe salvage in these patients is retrobulbar injections of amphotericin B. This study was conducted to review protocols, outcomes, and side effects of retrobulbar injection of amphotericin B in patients with COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM). METHODS The PubMed, Scopus, Web of Science, and Embase databases were searched using a comprehensive string of relevant keywords. All English studies with the confirmed diagnosis of CAM infection were included. We excluded all studies in which retrobulbar injection of amphotericin B was not implemented in any of the patients or there was a lack of clarified and detailed data about this procedure among participants. RESULTS A total of 647 cases had a history of retrobulbar injection(s) of amphotericin B in 13 reviewed studies with 3,132 subjects of CAM. The most common protocol was the retrobulbar injection of 1 ml of 3.5 mg/ml liposomal amphotericin B for 3 doses daily or on alternate days. We discerned that the globe salvage rate was 95.0% in eyes with a history of retrobulbar injection(s). The total rate of orbital exenteration was 14.9%, regardless of the history of retrobulbar injection of the drug. Other outcomes of this intervention were vision salvage and reduced major ophthalmic complaints, including pain, swelling, chemosis, ptosis, and ophthalmoplegia. The side effects of this intervention were not serious, and most of them were transient. They included swelling at the injection site, restriction of ocular motilities, exacerbation of orbital inflammation, and even intensification of visual impairment in a few cases. CONCLUSIONS Retrobulbar injection of amphotericin B should be considered a nearly safe and protective intervention against orbital exenteration in patients with CAM. It may also be effective in saving vision. Since the effectiveness of orbital exenteration in the survival of patients is not ascertained, retrobulbar injections can be considered an alternative intervention.
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Affiliation(s)
- Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Akbari
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shafie’ei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Naser Nasiri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Meraj Sharifi
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohadeseh Shafiei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Amin Zand
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
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12
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Kaufman AR, Labby AB, Pham C, Atwal GS, Dixon TK, Ozgen Mocan B, Lee VS. Chronic invasive fungal sinusitis with orbital and olfactory cleft involvement secondary to indolent mucormycosis. Am J Ophthalmol Case Rep 2022; 26:101448. [PMID: 35243178 PMCID: PMC8881357 DOI: 10.1016/j.ajoc.2022.101448] [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: 01/15/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Chronic invasive fungal sinusitis secondary to indolent mucormycosis is a rare clinical entity, and the ideal management is controversial. A case of indolent mucormycosis successfully managed with conservative debridement and retrobulbar amphotericin B is herein reported. Observations A 42-year-old man with diabetes mellitus and kidney transplant presented with chronic invasive fungal sinusitis with left orbital involvement from indolent mucormycosis. The patient was treated with aggressive systemic antifungal therapy, left retrobulbar injection of liposomal amphotericin B, reduction in immunosuppression, and conservative surgical debridement. Although the left olfactory cleft was involved, the cribriform plate was not resected due to risk of seeding the intracranial space. Given mild orbital involvement, no orbital debridement was performed and the patient had resolution of his orbital findings with systemic and retrobulbar amphotericin B. The patient had clinical and radiographic stability at 6-month follow-up. Conclusions Conservative resection with subsequent long-term antifungal treatment can be a successful regimen in indolent mucormycosis. Retrobulbar amphotericin B may be a prudent orbit-sparing adjuvant therapy in indolent mucormycosis.
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13
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Shabana RR, Eldesouky MA, Elbedewy HA. Exenterate or Not: A Simple Proposed Management Algorithm for Mucormycosis During the Era of COVID-19 in a Tertiary Eye Care Center in Egypt. Clin Ophthalmol 2022; 16:1933-1940. [PMID: 35720737 PMCID: PMC9199953 DOI: 10.2147/opth.s366067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To construct a simple management algorithm for cases with orbital mucormycosis during the COVID-19 era. Methods Retrospective study included records of 30 Egyptian patients with post COVID-19 orbital mucormycosis. They underwent full clinical examination, laboratory investigations, Computed tomography (CT)/magnetic resonance imaging (MRI) of the paranasal sinuses and pathological specimen examination. The proposed algorithm was based on all the available data of the included patients. Results The mean age of the studied patients was 62.47±11.13 years; 56.6% were females and 63.3% had uncontrolled diabetes mellitus. The main presentation was Orbital apex syndrome (OAS) in 43.3% of the cases. Twenty-six patients (86.6%) received systemic liposomal amphotericin B, while 4 patients (13.3%) received posaconazole. Orbital exenteration was done in 6 patients (20.0%), 4 of them died (66.7%). Twenty-four patients (80%) survived with clinical but not with visual improvement. Conclusion Systemic antifungal treatment and functional endoscopic sinus surgery (FESS) with extensive debridement of involved necrotic tissues were the main steps to control ROCM. Orbital exenteration should be kept for cases with periorbital tissue affection as it did not increase the final cure rate. The proposed management algorithm is supposed to be simple and easy to follow.
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Affiliation(s)
- Reham Refaat Shabana
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Gharbeya, Egypt
| | | | - Hazem A Elbedewy
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Gharbeya, Egypt
- Correspondence: Hazem A Elbedewy, Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Gharbeya, Egypt, Tel +201276732425, Email
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14
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Ashraf DC, Idowu OO, Hirabayashi KE, Kalin-Hajdu E, Grob SR, Winn BJ, Vagefi MR, Kersten RC. Outcomes of a Modified Treatment Ladder Algorithm Using Retrobulbar Amphotericin B for Invasive Fungal Rhino-Orbital Sinusitis. Am J Ophthalmol 2022; 237:299-309. [PMID: 34116011 DOI: 10.1016/j.ajo.2021.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess whether a modified treatment ladder algorithm incorporating transcutaneous retrobulbar amphotericin B (TRAMB) for invasive fungal rhino-orbital sinusitis can reduce the risk of exenteration without compromising survival. DESIGN Retrospective, comparative clinical study with historical control subjects. METHODS Fifty consecutive patients with biopsy-proven invasive fungal sinusitis and radiographic evidence of orbital involvement were evaluated at a single tertiary institution from 1999-2020. TRAMB was incorporated as part of the treatment algorithm in 2015. Demographics, underlying immune derangement, infective organism, ophthalmic examination, surgical care, and survival were compared in a quasiexperimental pre-post format, dividing patients into a pre-2015 group and a post-2015 group. Risk of exenteration and mortality were the primary outcomes. RESULTS Baseline characteristics did not differ significantly between the 2 groups. Nearly all patients underwent a surgical intervention, most commonly functional endoscopic sinus surgery with debridement. TRAMB was administered to 72.7% of the post-2015 group. Exenteration was more common in the pre-2015 group (36.4% vs 9.1% [95% confidence interval {CI} 5.2-48.8]; P = .014), while mortality was similar (40.0% vs 36.7% [95% CI -22.1 to 29.3]; P = .816). After adjusting for potential confounders, patients treated after 2015 were found to have lower risk of exenteration (relative risk 0.28 [95% CI 0.08-0.99]; P = .049) and similar risk of mortality (relative risk 1.04 [95% CI 0.50-2.16]; P = .919). CONCLUSION Compared with historical control subjects, patients with invasive fungal rhino-orbital sinusitis who were treated with a modified treatment ladder algorithm incorporating TRAMB had a lower risk of disfiguring exenteration without an apparent increase in the risk of mortality.
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Affiliation(s)
- Davin C Ashraf
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Oluwatobi O Idowu
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Kristin E Hirabayashi
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Evan Kalin-Hajdu
- Department of Ophthalmology (E.K-H.), Université de Montréal, Montreal, Quebec, Canada
| | - Seanna R Grob
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Bryan J Winn
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - M Reza Vagefi
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Robert C Kersten
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA.
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15
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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.
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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
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16
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Chiou CA, Yoon MK. An Update on Fungal Orbital Infections. Int Ophthalmol Clin 2022; 62:55-69. [PMID: 35325910 DOI: 10.1097/iio.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Singh P, Gupta A, Sanepalli SR, Raj A. Transcutaneous retrobulbar amphotericin-B (TRAMB) injection in orbital mucormycosis. BMJ Case Rep 2022; 15:15/3/e246307. [PMID: 35361668 PMCID: PMC8971798 DOI: 10.1136/bcr-2021-246307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We aim to highlight the role of transcutaneous retrobulbar amphotericin-B (TRAMB) in cases of rhino-orbital mucormycosis. With the COVID-19 pandemic a rapid surge in the number of cases of rhino-orbital mucormycosis has been noted. The gold standard treatment for the progressive orbital disease is exenteration; however, organ salvage should be attempted, when possible. Here comes the role of TRAMB injection. We present a case of a man in his 70s, a known diabetic, who recovered from COVID-19 pneumonia but developed left-sided axial proptosis with orbital apex syndrome and ophthalmic artery occlusion secondary to rhino-orbital mucormycosis. The patient underwent debridement of paranasal sinuses and received intravenous liposomal amphotericin-B and three TRAMB injections. After three TRAMB injections significant improvement in extraocular movements, proptosis and ptosis was noted. An early intervention in orbital disease can avert a more radical procedure.
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Affiliation(s)
- Prabhakar Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Abhishek Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | | | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
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18
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Drew RH, Perfect JR. Conventional Antifungals for Invasive Infections Delivered by Unconventional Methods; Aerosols, Irrigants, Directed Injections and Impregnated Cement. J Fungi (Basel) 2022; 8:jof8020212. [PMID: 35205966 PMCID: PMC8879564 DOI: 10.3390/jof8020212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 12/10/2022] Open
Abstract
The administration of approved antifungals via unapproved formulations or administration routes (such as aerosol, direct injection, irrigation, topical formulation and antifungal-impregnated orthopedic beads or cement) may be resorted to in an attempt to optimize drug exposure while minimizing toxicities and/or drug interactions associated with conventional (systemic) administrations. Existing data regarding such administrations are mostly restricted to uncontrolled case reports of patients with diseases refractory to conventional therapies. Attribution of efficacy and tolerability is most often problematic. This review updates prior published summaries, reflecting the most recent data and its application by available prevention and treatment guidelines for invasive fungal infections. Of the various dosage forms and antifungals, perhaps none is more widely reported than the application of amphotericin B-containing aerosols for the prevention of invasive mold infections (notably Aspergillus spp.).
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Affiliation(s)
- Richard H. Drew
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA;
- College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC 27506, USA
- Correspondence: ; Tel.: +1-(919)681-6793; Fax: +1-(919)681-7494
| | - John R. Perfect
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA;
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19
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Ghosh D, Dey S, Chakraborty H, Mukherjee S, Halder A, Sarkar A, Chakraborty P, Ghosh R, Sarkar J. Mucormycosis: A new threat to Coronavirus disease 2019 with special emphasis on India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022; 15:101013. [PMID: 35342843 PMCID: PMC8934183 DOI: 10.1016/j.cegh.2022.101013] [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] [Received: 09/07/2021] [Revised: 12/10/2021] [Accepted: 03/10/2022] [Indexed: 01/03/2023] Open
Abstract
The main reason for the growth of mucormycosis in people with Coronavirus disease-2019 (COVID-19) is mainly produced by Rhizopus spp. The infective mechanisms and issues recognized in Rhizopus spp. are the cell wall, germination proteins, and enzymes assisted to iron sequestration, CotH protein, and positive regulation of the GRP78 cell receptor. Mucormycosis is mainly caused by the Rhizopus spp. such as R. oryzae, R. microsporus, R. arrhizus, R. homothallicus, etc. that are gifted to numerous host defense mechanisms and attribute to the endothelium via specific receptors, GRP78 simplifying their endocytosis and angio-invasion. Factors such as hyperglycemia, elevated iron concentrations, and ketoacidosis have been shown to contribute to the pathogenesis in the tentative situation. The analytical data of 'black fungus disease' or 'mucormycosis', specify India reported for about 42.3% of published cases, followed by the USA about 16.9%, Iraq, Bangladesh, Iran, Paraguay, and 1 case each from Brazil, Mexico, Italy, UK, China, France, Uruguay, Turkey, and Austria. The COVID-19 infection is maybe a predisposing factor for mucormycosis and is related to a high mortality rate. Early recognition and restriction of hyperglycemia, liposomal amphotericin B, and surgical debridement are the bases in the successful managing of mucormycosis.
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Affiliation(s)
- Deganta Ghosh
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Sagardeep Dey
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Himanko Chakraborty
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Sneha Mukherjee
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Ankita Halder
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Akash Sarkar
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Pallab Chakraborty
- Department of Botany, Acharya Prafulla Chandra College, New Barrakpur, Kolkata, West Bengal, India, 700131
| | - Rajdeep Ghosh
- GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India, 533296
| | - Joy Sarkar
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084,Corresponding author
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20
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Murthy R, Bagchi A, Gote Y, Desai S. Retrobulbar injection of amphotericin B using intravenous cannula for post-COVID-19 rhino-orbital mucormycosis. Indian J Ophthalmol 2021; 70:302-305. [PMID: 34937263 PMCID: PMC8917598 DOI: 10.4103/ijo.ijo_1511_21] [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] [Indexed: 11/05/2022] Open
Abstract
Rhino-orbital mucormycosis has seen a huge resurgence in patients post COVID-19 infection. In patients with minimal orbital disease and especially with preserved vision, retrobulbar injections of amphotericin B can be of great help in controlling the disease. Instead of giving daily injections of amphotericin B using needles every time, we used an 18-gauge intravenous (IV) cannula with injection port and suture holes to deliver the amphotericin into the orbital space for a period of 5 days. Patients were more compliant and less distressed with this method compared with being given an injection with a needle daily. We got a good response in terms of orbital disease regression with this method. In our review of the literature, we did not come across any such case of amphotericin B injection using an IV cannula. Injection of amphotericin B into the orbit using an IV cannula is a viable and easy treatment option for cases of rhino-orbital mucormycosis.
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Affiliation(s)
- Ramesh Murthy
- Department of Ophthalmology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Aadhyaa Bagchi
- Department of Ophthalmology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Yogita Gote
- Department of Ophthalmology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Sanjay Desai
- Department of Radiology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
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21
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Choksi T, Agrawal A, Date P, Rathod D, Gharat A, Ingole A, Chaudhari B, Pawar N. Cumulative Mortality and Factors Associated With Outcomes of Mucormycosis After COVID-19 at a Multispecialty Tertiary Care Center in India. JAMA Ophthalmol 2021; 140:66-72. [PMID: 34882192 DOI: 10.1001/jamaophthalmol.2021.5201] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance An outbreak of COVID-19-associated rhino-orbitocerebral mucormycosis (CAM) has occurred in many parts of the world. Although the clinical profile and risk factors for CAM have been studied, cumulative mortality and its risk factors have not. Objective To report the cumulative mortality rates at different times in cases with CAM and identify risk factors for CAM-associated mortality. Design, Setting, and Participants This retrospective case-control study was conducted from March 1 to May 30, 2021, in a tertiary care multispecialty hospital in western India. All patients diagnosed with CAM and with a minimum follow-up of 30 days or those who died before 30 days due to CAM were included. Main Outcomes and Measure Cumulative mortality in CAM using survival analysis. Results A total of 73 consecutive patients with CAM with a mean (SD) age of 53.5 (12.5) years were included in the analysis, of whom 48 (66%) were men. CAM developed at a median of 28 (IQR, 15-45; range, 4-90) days after recovery from COVID-19. Of the 73 patients with CAM, 26 (36%) died; the cumulative probability of death was 26% (95% CI, 16%-41%) at day 7 and doubled to 53% (95% CI, 39%-69%) at day 21. Sinus debridement was performed in 18 of 51 patients (35%), and 5 of 52 (10%) underwent exenteration, whereas intravenous lyophilized amphotericin B was administered to 48 patients (66%). A multivariate Cox proportional hazards regression analysis showed that receiving mechanical ventilation in the past was associated with a nearly 9-fold increased risk of death (hazard ratio [HR], 8.98; 95% CI, 2.13-38.65; P = .003), and patients who had visual acuity of light perception or better had a 46% lower risk of death (HR, 0.56; 95% CI, 0.32-0.98; P = .04). Intravenous amphotericin B administration was associated with a reduced rate of exenteration (0 vs 5 of 25 [20%]; P < .001). On multivariate analysis, those who received intravenous amphotericin B had a 69% reduced risk of death (HR, 0.31; 95% CI, 0.06-1.43; P = .13). Conclusions and Relevance These findings suggest that the mortality rate after rhino-orbitocerebral mucormycosis is high and that a subgroup of patients with severe COVID-19 or presenting with severe orbital disease are more likely to die within 10 days of admission.
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Affiliation(s)
- Twinkle Choksi
- Department of Ophthalmology, Topiwala National Medical College, BYL Nair Charitable Hospital, Mumbai Central, Mumbai, India
| | - Anamika Agrawal
- Department of Ophthalmology, Topiwala National Medical College, BYL Nair Charitable Hospital, Mumbai Central, Mumbai, India
| | - Purva Date
- Department of Ophthalmology, Topiwala National Medical College, BYL Nair Charitable Hospital, Mumbai Central, Mumbai, India
| | - Darshana Rathod
- Department of Ophthalmology, Topiwala National Medical College, BYL Nair Charitable Hospital, Mumbai Central, Mumbai, India
| | - Anuja Gharat
- Department of Ophthalmology, Topiwala National Medical College, BYL Nair Charitable Hospital, Mumbai Central, Mumbai, India
| | - Avinash Ingole
- Department of Ophthalmology, Topiwala National Medical College, BYL Nair Charitable Hospital, Mumbai Central, Mumbai, India
| | - Bhushan Chaudhari
- Department of Ophthalmology, Topiwala National Medical College, BYL Nair Charitable Hospital, Mumbai Central, Mumbai, India
| | - Nitin Pawar
- Department of Ophthalmology, Topiwala National Medical College, BYL Nair Charitable Hospital, Mumbai Central, Mumbai, India
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22
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Kaur K, Gurnani B. Rhino-orbital-cerebral mucormycosis in COVID-19 patients - Taming the black evil with pharmacological weapons. Indian J Pharmacol 2021; 53:417-419. [PMID: 34854414 PMCID: PMC8641742 DOI: 10.4103/ijp.ijp_392_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kirandeep Kaur
- Consultant Cataract, Pediatric Ophthalmology and Strabismus Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Puducherry, India
| | - Bharat Gurnani
- Consultant Cataract, Cornea and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Puducherry, India
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23
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Nair AG, Dave TV. Transcutaneous retrobulbar injection of amphotericin B in rhino-orbital-cerebral mucormycosis: a review. Orbit 2021; 41:275-286. [PMID: 34720026 DOI: 10.1080/01676830.2021.1990351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mucormycosis is an aggressive and potentially fatal invasive fungal infection. The most common form of mucormycosis is rhino-orbital-cerebral mucormycosis (ROCM). While it is commonly seen in immunocompromised patients, it is also known to affect healthy individuals. The global disease burden of ROCM has increased significantly following the surge in cases during the COVID-19 pandemic. Endoscopic sinus debridement, systemic antifungal therapy, and control of the underlying immunosuppressive condition are essential for the management of ROCM. Orbital involvement, however, presents a challenge to clinicians. Intervention strategies that have been described to treat orbital disease include orbital exenteration, conservative orbital debridement with or without irrigation with amphotericin B and transcutaneous retrobulbar injection of amphotericin B (TRAMB). Currently, there is a lack of clarity regarding the indications and outcomes of TRAMB as a treatment modality. In this review, the drug formulations used, the complications, and outcomes of previously described cases that have used TRAMB in cases of ROCM are discussed. Favorable outcomes following TRAMB depend on appropriate patient selection and radiological evidence of the orbital burden of the disease. This review aims to familiarize clinicians with objective parameters for patient selection for TRAMB, namely the extent of the disease, the clinical features, and radiological findings; viz. the clinical interpretation of areas of contrast uptake and those of necrosis. TRAMB can be considered as a viable option in select cases of orbital mucormycosis where exenteration or debridement are not indicated, or when there is limited orbital disease.
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Affiliation(s)
- Akshay Gopinathan Nair
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, India.,Advanced Eye Hospital & Institute, Navi Mumbai, India.,Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.,Ophthalmic Plastic Surgery and Ocular Oncology Services, R. Jhunjhunwala Sankara Eye Hospital, Panvel, India
| | - Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, India
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Singh K, Kumar S, Shastri S, Sudershan A, Mansotra V. Black fungus immunosuppressive epidemic with Covid-19 associated mucormycosis (zygomycosis): a clinical and diagnostic perspective from India. Immunogenetics 2021; 74:197-206. [PMID: 34596728 PMCID: PMC8484850 DOI: 10.1007/s00251-021-01226-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023]
Abstract
The catastrophic phase of Covid-19 turns the table over with the spread of its disastrous transmission network throughout the world. Covid-19 associated with mucormycosis fungal infection accompanied by opportunistic comorbidities have emerged the myriad of complications and manifestations. We searched the electronic databases of Google Scholar, PubMed, Springer, and Elsevier until June 05, 2021, using keywords. We retrieved the details of confirmed and suspected mucormycosis patients associated with Covid-19. We analyzed the case reports, treatment given for Covid-19, steroids used, associated comorbidities, mucormycosis site involved, and patients survived or dead. Overall, 102 patients of mucormycosis associated with Covid-19 have been reported from India. Mucormycosis was predominant in males (69.6%) rather than females (19.6%), and most of the patients were active Covid-19 cases (70.5%). Steroids were mostly used (68.6%) for the treatment of Covid-19 followed by remdesivir (10.7%). Patients were suffering from diabetes mellitus (88.2%) and severe diabetic ketoacidosis (11.7%). Mucormycosis affects the sino-nasal (72.5%), orbit (24.5%), central nervous system (18.6%), and maxillary necrosis (13.7%) of the patients. The Mortality rate was recorded as 23.5%, and recovery rate was 2.9%. Diabetes mellitus cases are highest in India as compared to other countries, and prevalent use of steroids with the background of Covid-19 becomes an opportunistic environment for mucormycosis fungal infection to survive.
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Affiliation(s)
- Kuljeet Singh
- Department of Computer Science & IT, University of Jammu, Jammu & Kashmir 180006, Jammu, India.
| | - Sachin Kumar
- Department of Computer Science & IT, University of Jammu, Jammu & Kashmir 180006, Jammu, India
| | - Sourabh Shastri
- Department of Computer Science & IT, University of Jammu, Jammu & Kashmir 180006, Jammu, India
| | - Amrit Sudershan
- Institute of Human Genetics, University of Jammu, Jammu & Kashmir 180006, Jammu, India
| | - Vibhakar Mansotra
- Department of Computer Science & IT, University of Jammu, Jammu & Kashmir 180006, Jammu, India
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COVID-19 associated mucormycosis: Staging and management recommendations (Report of a multi-disciplinary expert committee). J Oral Biol Craniofac Res 2021; 11:569-580. [PMID: 34395187 PMCID: PMC8354814 DOI: 10.1016/j.jobcr.2021.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 12/26/2022] Open
Abstract
Even before the onslaught of COVID-19 pandemic could settle, the unprecedented rise in cases with COVID-19 associated mucormycosis pushed the medical health to the fringe. Hyperglycaemia and corticosteroids appear to be the most consistent associations leading to the commonest manifestation of mucormycosis, Rhino-Orbito-Cerebral Mucormycosis. To address challenges right from categorisation and staging of the disease to the management of relentless progression, a multi-disciplinary expert committee was formed to handle the task in an evidence-based format to enforce best practices. The report of the committee on one hand attempts to succinctly present the currently available evidence while at the other also attempts to bridge the evidence-deficient gaps with the specialty-specific virtuosity of experts.
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26
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Sen M, Honavar SG, Bansal R, Sengupta S, Rao R, Kim U, Sharma M, Sachdev M, Grover AK, Surve A, Budharapu A, Ramadhin AK, Tripathi AK, Gupta A, Bhargava A, Sahu A, Khairnar A, Kochar A, Madhavani A, Shrivastava AK, Desai AK, Paul A, Ayyar A, Bhatnagar A, Singhal A, Nikose AS, Bhargava A, Tenagi AL, Kamble A, Nariani A, Patel B, Kashyap B, Dhawan B, Vohra B, Mandke C, Thrishulamurthy C, Sambare C, Sarkar D, Mankad DS, Maheshwari D, Lalwani D, Kanani D, Patel D, Manjandavida FP, Godhani F, Agarwal GA, Ravulaparthi G, Shilpa GV, Deshpande G, Thakkar H, Shah H, Ojha HR, Jani H, Gontia J, Mishrikotkar JP, Likhari K, Prajapati K, Porwal K, Koka K, Dharawat KS, Ramamurthy LB, Bhattacharyya M, Saini M, Christy MC, Das M, Hada M, Panchal M, Pandharpurkar M, Ali MO, Porwal M, Gangashetappa N, Mehrotra N, Bijlani N, Gajendragadkar N, Nagarkar NM, Modi P, Rewri P, Sao P, Patil PS, Giri P, Kapadia P, Yadav P, Bhagat P, Parekh R, Dyaberi R, Chauhan RS, Kaur R, Duvesh RK, Murthy R, Dandu RV, Kathiara R, Beri R, Pandit R, Rani RH, Gupta R, Pherwani R, Sapkal R, Mehta R, Tadepalli S, Fatima S, Karmarkar S, Patil SS, Shah S, Shah S, Shah S, Dubey S, Gandhi S, Kanakpur S, Mohan S, Bhomaj S, Kerkar S, Jariwala S, Sahu S, Tara S, Maru SK, Jhavar S, Sharma S, Gupta S, Kumari S, Das S, Menon S, Burkule S, Nisar SP, Kaliaperumal S, Rao S, Pakrasi S, Rathod S, Biradar SG, Kumar S, Dutt S, Bansal S, Ravani SA, Lohiya S, Rizvi SWA, Gokhale T, Lahane TP, Vukkadala T, Grover T, Bhesaniya T, Chawla U, Singh U, Une VL, Nandedkar V, Subramaniam V, Eswaran V, Chaudhary VN, Rangarajan V, Dehane V, Sahasrabudhe VM, Sowjanya Y, Tupkary Y, Phadke Y. Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1. Indian J Ophthalmol 2021; 69:1670-1692. [PMID: 34156034 PMCID: PMC8374756 DOI: 10.4103/ijo.ijo_1565_21] [Citation(s) in RCA: 209] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.
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Affiliation(s)
| | | | | | | | - Raksha Rao
- Narayana Netralaya, Bengaluru, Karnataka, India
| | - Usha Kim
- Aravind Eye Care, Madurai, Tamil Nadu, India
| | | | | | - Ashok K Grover
- Department of Ophthalmology, Sir Ganga Ram Hospital and Vision Eye Centres, New Delhi, India
| | - Abhidnya Surve
- Department of Ophthalmology, Dr. Hedgewar Rugnalaya, Aurangabad, Maharashtra, India
| | - Abhishek Budharapu
- Department of Head and Neck Surgery, Apollo Cancer Hospital, Hyderabad, Telangana, India
| | - Abhishek K Ramadhin
- Department of Otorhinolaryngology, Dr Abhishek K. Ramadhin Hospital and Avyaan Research Centre, Ranchi, Jharkhand, India
| | | | - Adit Gupta
- Mumbai Eye Plastic Surgery, Maharashtra, India
| | - Aditya Bhargava
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Animesh Sahu
- Retina Speciality Hospital, Indore, Madhya Pradesh, India
| | - Anjali Khairnar
- Department of Ophthalmology, Shree Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - Anju Kochar
- Department of Ophthalmology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Ankita Madhavani
- Department of Ophthalmology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India
| | - Ankur K Shrivastava
- Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Anuja K Desai
- Department of Ophthalmology, Kusum Dhirajlal Hospital, Ahmedabad, Gujarat, India
| | - Anujeet Paul
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | | | - Aparna Bhatnagar
- Department of Ophthalmology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - Aparna Singhal
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Archana Sunil Nikose
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India
| | - Arun Bhargava
- Retina Speciality Hospital, Indore, Madhya Pradesh, India
| | - Arvind L Tenagi
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Karnataka Lingayat Education Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Ashish Kamble
- Department of Ophthalmology, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Ashiyana Nariani
- Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Bhavin Patel
- Department of Otorhinolaryngology, Kiran Super Multi-Speciality Hospital, Surat, Gujarat, India
| | | | - Bodhraj Dhawan
- Department of Ophthalmology, Alexis Hospital, Nagpur, Maharashtra, India
| | - Busaraben Vohra
- Department of Ophthalmology, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, Gujarat, India
| | - Charuta Mandke
- Department of Ophthalmology, Hinduhridaysamrat Balasaheb Thackeray Medical College & Dr. R. N. Cooper Municipal Hospital, Mumbai, Maharashtra, India
| | - Chinmayee Thrishulamurthy
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Chitra Sambare
- Department of Ophthalmology, Jehangir Hospital, Pune, Maharashtra, India
| | - Deepayan Sarkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Dhwani Maheshwari
- Department of Ophthalmology, Sir Sayajirao Gaekwad Hospital, Vadodra, Gujarat, India
| | | | - Dipti Kanani
- Department of Ophthalmology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India
| | - Diti Patel
- Department of Ophthalmology, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, Gujarat, India
| | | | - Frenali Godhani
- Department of Ophthalmology, Jagjivan Ram Railway Hospital, Mumbai, Maharashtra, India
| | - Garima Amol Agarwal
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Gayatri Ravulaparthi
- Department of Ophthalmology, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India
| | | | | | - Hansa Thakkar
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Hardik Shah
- Department of Otorhinolaryngology, Kusum Dhirajlal Hospital, Ahmedabad, Gujarat, India
| | | | - Harsha Jani
- Department of Ophthalmology, Pramukh Swami Medical College, Karamsad, Gujarat, India
| | - Jyoti Gontia
- Department of Ophthalmology, Maharaja Yeshwantrao Hospital, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Jyotika P Mishrikotkar
- Department of Ophthalmology, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India
| | | | - Kamini Prajapati
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Kavita Porwal
- Department of Ophthalmology, Convenient Hospitals Limited (CHL) – Hospitals, Indore, Madhya Pradesh, India
| | - Kirthi Koka
- Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Lakshmi B Ramamurthy
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | | | - Manorama Saini
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | | | - Mausumi Das
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Maya Hada
- Department of Ophthalmology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Mehul Panchal
- Department of Microbiology, Kiran Super Multi-Speciality Hospital, Surat, Gujarat, India
| | | | | | | | - Nagaraju Gangashetappa
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Neelima Mehrotra
- Department of Ophthalmology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Neha Bijlani
- Vision Care & Research Centre, Bhopal, Madhya Pradesh, India
| | | | - Nitin M Nagarkar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Palak Modi
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Parveen Rewri
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Piyushi Sao
- Department of Ophthalmology, Shri Mallanagouda Basanagouda Patil Medical College, BLDE University, Vijayapura, Karnataka, India
| | - Prajakta Salunkhe Patil
- Department of Ophthalmology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Pramod Giri
- Max Vision Eye Hospital, Nagpur, Maharashtra, India
| | - Priti Kapadia
- Department of Ophthalmology, Government Medical College, Surat, Gujarat, India
| | - Priti Yadav
- Department of Ophthalmology, Maharaja Yeshwantrao Hospital, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Purvi Bhagat
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Ragini Parekh
- Department of Ophthalmology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, Maharashtra, India
| | - Rajashekhar Dyaberi
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Rajender Singh Chauhan
- Regional Institute of Ophthalmology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rajwinder Kaur
- Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bhatinda, Punjab, India
| | - Ram Kishan Duvesh
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Ravi Varma Dandu
- Department of Neuroradiology, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Ravija Kathiara
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Renu Beri
- Department of Ophthalmology, Civil Hospital Ambala Cantonment, Haryana, India
| | - Rinal Pandit
- Department of Ophthalmology, Choithram Hospital & Research Centre, Indore, Madhya Pradesh, India
| | - Rita Hepsi Rani
- Department of Ophthalmology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India
| | | | - Ruchi Pherwani
- Department of Ophthalmology, SMBT Institute of Medical Sciences and Research Centre, Nashik, Maharashtra, India
| | - Rujuta Sapkal
- Department of Ophthalmology, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India
| | - Rupa Mehta
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sameeksha Tadepalli
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Samra Fatima
- Sarojini Devi Eye Hospital, Hyderabad, Telangana, India
| | - Sandeep Karmarkar
- Department of Otorhinolaryngology, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Sanjana Shah
- Department of Ophthalmology, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, Gujarat, India
| | - Sankit Shah
- Department of Ophthalmology, Kiran Super Multi-Speciality Hospital, Surat, Gujarat, India
| | - Sapan Shah
- Department of Ophthalmology, Kusum Dhirajlal Hospital, Ahmedabad, Gujarat, India
| | - Sarika Dubey
- Department of Ophthalmology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | | | - Savitha Kanakpur
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Shalini Mohan
- Department of Ophthalmology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India
| | | | - Sheela Kerkar
- Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Shivani Jariwala
- Department of Ophthalmology, Government Medical College, Surat, Gujarat, India
| | - Shivati Sahu
- Department of Ophthalmology, Maharaja Yeshwantrao Hospital, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | | | - Shruti Kochar Maru
- Department of Ophthalmology, Convenient Hospitals Limited (CHL) – Hospitals, Indore, Madhya Pradesh, India
| | - Shubha Jhavar
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | - Shubhda Sharma
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Shweta Gupta
- Sankara Eye Foundation, Indore, Madhya Pradesh, India
| | - Shwetha Kumari
- Department of Ophthalmology, Bowring and Lady Curzon Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sima Das
- Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Smita Menon
- Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Snehal Burkule
- Department of Ophthalmology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
| | | | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Subramanya Rao
- Department of Otorhinolaryngology, Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Sudipto Pakrasi
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Sujatha Rathod
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sunil G Biradar
- Department of Ophthalmology, Shri Mallanagouda Basanagouda Patil Medical College, BLDE University, Vijayapura, Karnataka, India
| | - Suresh Kumar
- Department of Ophthalmology, Government Medical College, Chandigarh, India
| | - Susheen Dutt
- Department of Otorhinolaryngology, Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Svati Bansal
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Swati Amulbhai Ravani
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Sweta Lohiya
- Department of Otorhinolaryngology, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Syed Wajahat Ali Rizvi
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Tanmay Gokhale
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Tatyarao P Lahane
- Department of Ophthalmology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, Maharashtra, India
| | | | - Triveni Grover
- Department of Ophthalmology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Trupti Bhesaniya
- Department of Ophthalmology, Government Medical College, Surat, Gujarat, India
| | - Urmil Chawla
- Regional Institute of Ophthalmology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Usha Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vaishali L Une
- Department of Ophthalmology, Shree Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - Varsha Nandedkar
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | | | - Vidya Eswaran
- Department of Ophthalmology, Bowring and Lady Curzon Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Vidya Nair Chaudhary
- Department of Ophthalmology, Aakash Healthcare Super-Specialty Hospital, New Delhi, India
| | | | - Vipin Dehane
- Department of Oral and Maxillofacial Surgery, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Vivek M Sahasrabudhe
- Department of Ophthalmology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
| | | | - Yashaswini Tupkary
- Department of Medicine, Dr. Hedgewar Rugnalaya, Aurangabad, Maharashtra, India
| | - Yogita Phadke
- Department of Ophthalmology, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India
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Blessing NW, Chen Y, Choi CJ, Kanokkantapong J, Tao W, Pelaez D, Lee BW. Orbital Hemorrhagic Necrosis, Globe Rupture, and Death From Intraorbital Injection of 1% Sodium Deoxycholate in a Murine Model. Ophthalmic Plast Reconstr Surg 2021; 37:S98-S103. [PMID: 33060511 DOI: 10.1097/iop.0000000000001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Deoxycholic acid (DCA) 1% is an injectable detergent indicated for submental fat reduction, although clinically it is being injected off-label for orbital fat prolapse. It is known to cause severe inflammation, local nerve dysfunction, and tissue necrosis, all of which could be catastrophic in the orbit and periocular region. This study evaluated the effects of periocular DCA on orbital and ocular adnexal tissues in a murine model. METHODS Mice were treated via split-face intraorbital injections, subcutaneous injections, and topical cornea application with DCA versus phosphate-buffered saline. Whole heads were fixed, decalcified, and sectioned for orbital histology after 1-7 days. Matched pairs of human globes and mouse globes were immersed in either phosphate-buffered saline or 1% DCA for 72 hours. RESULTS Six of 11 mice receiving intraorbital DCA injections died within minutes. Surviving mice developed severe orbital inflammatory necrosis. All orbits injected with phosphate-buffered saline were clinically and histologically normal. Six mice were treated with lower concentrations of DCA and all developed variable amounts of orbital inflammation, hemorrhage, and globe necrosis. Mice receiving subcutaneous DCA injection to the lower eyelid showed inflammatory necrosis, edema, and lid malposition. Topical application of DCA to mouse corneas caused no external or histologic changes. Human and mouse globes immersed ex vivo in DCA developed corneal edema and cataract formation without observable scleral changes. CONCLUSION Intraorbital and periocular injection of DCA can cause devastating complications in a murine model, and significant caution is advised for off-label use in the periocular region.
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Affiliation(s)
- Nathan W Blessing
- Oculofacial Plastic & Reconstructive Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Oculofacial Plastic & Reconstructive Surgery, Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Ying Chen
- Oculofacial Plastic & Reconstructive Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Catherine J Choi
- Oculofacial Plastic & Reconstructive Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jugchawin Kanokkantapong
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Wensi Tao
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Daniel Pelaez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Bradford W Lee
- Oculofacial Plastic & Reconstructive Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a Viral Land: A Tale of Two Pathogens. Indian J Ophthalmol 2021; 69:244-252. [PMID: 33463566 PMCID: PMC7933891 DOI: 10.4103/ijo.ijo_3774_20] [Citation(s) in RCA: 182] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment. Methods: We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue. Results: All patients were male, mean age 60.5 ± 12 (46.2–73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86–404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3–42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy. Conclusion: Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival.
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Affiliation(s)
- Mrittika Sen
- Ophthalmic and Facial Plastic Surgery and Ocular Oncology Services, Centre for Sight, Hyderabad, India
| | - Sumeet Lahane
- Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Tatyarao P Lahane
- Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Ragini Parekh
- Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Santosh G Honavar
- Ophthalmic and Facial Plastic Surgery and Ocular Oncology Services, Centre for Sight, Hyderabad, India
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29
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Chen AJ, Ediriwickrema LS, Verma R, Vavinskaya V, Shaftel S, Deconde AS, Korn BS, Kikkawa DO, Liu CY. A case of mistaken identity: Saksenaea vasiformis of the orbit. Orbit 2020; 40:521-524. [PMID: 32862746 DOI: 10.1080/01676830.2020.1814354] [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: 10/23/2022]
Abstract
The authors describe a rare presentation of invasive fungal rhino-orbital cellulitis caused by Saksenaea vasiformis in an immunocompetent child. The patient was initially diagnosed and treated as Mucoraceae, which has a high mortality rate and is primarily seen in immunocompromised patients. Though of the same order, Mucorales, the families Mucoraceae and Saksenaeacae, may be difficult to differentiate on histologic examination and must be distinguished by fungal culture and speciation. Our patient responded well to sino-orbital debridement and systemic treatment with amphotericin and posaconazole.
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Affiliation(s)
- Allison J Chen
- Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| | - Lilangi S Ediriwickrema
- Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| | - Rohan Verma
- Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| | | | - Solomon Shaftel
- Department of Ophthalmology, Kaiser Permanente, San Diego, California, USA
| | - Adam S Deconde
- Division of Otolaryngology, Head and Neck Surgery, UC San Diego, La Jolla, CA, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA.,Division of Plastic Surgery, UC San Diego, La Jolla, CA, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA.,Division of Plastic Surgery, UC San Diego, La Jolla, CA, USA
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
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30
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Martel A, Nahon-Esteve S, Gastaud L, Bertolotto C, Lassalle S, Baillif S, Charles A. Incidence of Orbital Exenteration: A Nationwide Study in France over the 2006-2017 Period. Ophthalmic Epidemiol 2020; 28:169-174. [PMID: 32693661 DOI: 10.1080/09286586.2020.1795887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Orbital exenteration is a radical and disfiguring surgery mainly performed for treating orbital malignancies. Recently, several studies found favorable results in terms of overall survival with eye-sparing surgeries combined with targeted therapies and/or radiotherapy. The aim of this study was to assess the incidence of orbital exenteration and its evolution in France between 2006 and 2017. METHODS A national observational cohort study was conducted in France between January 2006 and December 2017. Data were collected from the national PMSI (Programme de Médicalisation des Systèmes d'Information) database provided by the CNAM (Caisse Nationale de l'Assurance Maladie). All patients undergoing orbital exenteration over the study period in France were included. RESULTS One thousand and fifty-seven patients were included. The mean annual number of orbital exenterations was 88.1 (63-117), corresponding to a mean incidence of 0.1/100,000 inhabitants/year. A male predominance was noted (n = 626, 59.2%). Exenteration was mainly performed between 75 and 79 years. The underlying etiology was available for 821 patients (77.7%): malignancies were the most common (n = 755; 92.0%) followed by infectious diseases (n = 16; 1.9%). Over the study period, no statistical difference in the mean incidence of orbital exenteration was found (p = .132). CONCLUSION The mean annual incidence of orbital exenteration was 0.1/100,000 inhabitants in France and was not significantly modified during the study period.
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Affiliation(s)
- A Martel
- Ophthalmology Department, University Hospital of Nice, Nice, France
| | - S Nahon-Esteve
- Ophthalmology Department, University Hospital of Nice, Nice, France
| | - L Gastaud
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | - C Bertolotto
- Inserm, C3M, Université Côte d'Azur, Nice, France
| | - S Lassalle
- Laboratory of Clinical and Experimental Pathology, Côte d'Azur University, FHU OncoAge, Pasteur Hospital, University Hospital of Nice, Nice, France
| | - S Baillif
- Ophthalmology Department, University Hospital of Nice, Nice, France
| | - A Charles
- Ophthalmology Department, University Hospital of Nice, Nice, France
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31
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Safi M, Ang MJ, Patel P, Silkiss RZ. Rhino-orbital-cerebral mucormycosis (ROCM) and associated cerebritis treated with adjuvant retrobulbar amphotericin B. Am J Ophthalmol Case Rep 2020; 19:100771. [PMID: 32551404 PMCID: PMC7287239 DOI: 10.1016/j.ajoc.2020.100771] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose We report a case of rhino-orbital-cerebral mucormycosis (ROCM) with focal anterior cerebritis treated favorably with retrobulbar amphotericin B and systemic antifungals. Observations A 55-year-old diabetic male presented to the emergency department with left sided proptosis, left temple headache, maxillary sinus pain, and diplopia of 3 days duration. Biopsy results from the left middle turbinate, ethmoid, and maxillary sinus revealed broad and irregular non-septate hyphae consistent with mucormycosis. Despite treatment with intravenous antifungals and endoscopic debridement of the sinuses, his condition did not improve. Disease progression included the development of left ophthalmoplegia and left-sided cerebritis. The patient received retrobulbar injection of deoxycholate amphotericin B with eventual disease resolution, without exenteration. Conclusions We present a case of ROCM with associated cerebritis that responded to retrobulbar amphotericin B, without exenteration.
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Affiliation(s)
- Mustafa Safi
- California Pacific Medical Center, San Francisco, CA, United States
| | - Michael J Ang
- California Pacific Medical Center, San Francisco, CA, United States
| | - Poorav Patel
- California Pacific Medical Center, San Francisco, CA, United States
| | - Rona Z Silkiss
- California Pacific Medical Center, San Francisco, CA, United States.,Silkiss Eye Surgery, San Francisco, CA, United States
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32
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Geyman LS, Pham CM, Aakalu VK. Acute-Onset Visual Acuity Loss in a Man With Advanced Diabetes Mellitus. JAMA Ophthalmol 2020; 138:416-417. [PMID: 32077892 DOI: 10.1001/jamaophthalmol.2019.5388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Chau M Pham
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago
| | - Vinay K Aakalu
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago
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Topilow NJ, Tran AQ, Koo EB, Alabiad CR. Etiologies of Proptosis: A review. INTERNAL MEDICINE REVIEW (WASHINGTON, D.C. : ONLINE) 2020; 6:10.18103/imr.v6i3.852. [PMID: 32382689 PMCID: PMC7204542 DOI: 10.18103/imr.v6i3.852] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Proptosis, the protrusion of the eyeball from the orbit, results from a wide variety of pathologies that can be vision- or life-threatening. Clinical history, associated physical exam findings, and imaging features are all crucial in establishing the underlying etiology. The differential diagnosis is broad, and includes infectious, inflammatory, vascular, and neoplastic entities that range from benign and indolent, to malignant and aggressive. While treatment varies significantly based on the disease process, all are aimed at preserving vision, salvaging the globe, preventing disfigurement, and reducing mortality. Both internists and general ophthalmologists should be familiar with the causes of proptosis in order to initiate the work-up for, and appropriately triage, affected patients.
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Affiliation(s)
- Nicole J Topilow
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Ann Q Tran
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Eubee B Koo
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Chrisfouad R Alabiad
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
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34
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Lee AS, Lee PWY, Allworth A, Smith T, Sullivan TJ. Orbital mycoses in an adult subtropical population. Eye (Lond) 2019; 34:1640-1647. [PMID: 31822858 PMCID: PMC7608426 DOI: 10.1038/s41433-019-0733-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/28/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
Background/objectives To report the spectrum of fungal infections involving the orbit encountered in an Australian subtropical population with respect to presentation, host risk factors, involved pathogens, treatment and outcomes. Subjects/methods A retrospective chart review was performed on all adult patients with orbital mycosis treated by the senior author (TJS) from 1986 to 2017 in a tertiary setting. Results Thirty cases of fungal infection involving the orbit were included in this case series. Of these, 26 patients had invasive disease and four patients had non-invasive disease. Causative organisms included mucormycosis (16), aspergillus (8) and other fungi (7). Common risk factors included haematological disorders or malignancy, neutropenia, corticosteroid use and diabetes mellitus. Mucormycosis in three immunocompetent patients was caused by Apophysomyces elegans. Orbital apex syndrome was observed in approximately one third of patients at initial ophthalmological assessment. Amphotericin B was used in most cases of mucormycosis, while there was a more varied spectrum of anti-fungal use in other fungal infections. Seven patients with mucormycosis proceeded to orbital exenteration with a survival rate of 43%. No patients with other orbital fungal infections were exenterated. Conclusions Orbital mycoses are not only opportunistic but true pathogenic infections. While initial symptoms may be varied, the development of orbital apex syndrome should raise suspicion for this condition, regardless of patient immune status or age. Survival and visual outcomes are often poor with invasive disease. Multidisciplinary team management with early orbital specialist involvement is essential.
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Affiliation(s)
- Allister S Lee
- Department of Ophthalmology, Royal Brisbane and Women's Hospital (RBWH), Brisbane, QLD, Australia. .,University of Queensland, Brisbane, QLD, Australia.
| | - Princeton W Y Lee
- Department of Ophthalmology, Royal Brisbane and Women's Hospital (RBWH), Brisbane, QLD, Australia
| | - Anthony Allworth
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Tai Smith
- Queensland Eye Institute, Brisbane, Australia
| | - Timothy J Sullivan
- Department of Ophthalmology, Royal Brisbane and Women's Hospital (RBWH), Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
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35
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Martel A, Hamedani M, Lagier J, Bertolotto C, Gastaud L, Poissonnet G. [Does orbital exenteration still has a place in 2019?]. J Fr Ophtalmol 2019; 43:152-174. [PMID: 31831277 DOI: 10.1016/j.jfo.2019.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Orbital exenteration is a radical anatomically and psychologically disfiguring procedure. It is mostly performed for management of orbital cancers or cancers with orbital involvement. The lack of benefit in terms of overall survival and the development of new molecular therapies (targeted therapies, immunotherapy) in recent years leads us to question its use. The goal of our review is to answer to the following question: is orbital exenteration a viable procedure in 2019? MATERIALS AND METHODS A literature review was performed using the PUBMED and MEDLINE databases. The following terms were used then crossed with each other: "orbital exenteration", "exenterated socket", "overall survival", "life expectancy", "orbital reconstruction", "socket reconstruction". Oncology articles from the past 15 years were included and separated into those in the oculoplastic literature and those in the ENT literature. RESULTS Nineteen articles were included in this review. Eyelid tumours represent the main etiology of orbital exenteration. Basal cell carcinoma is the most frequently incriminated tumor, while sebaceous carcinoma and conjunctival squamous cell carcinoma are the most frequently encountered in Asian series. Non-conservative orbital exenteration is the most prevalent surgery performed. Orbital reconstruction depends on the surgeon's speciality: healing by secondary intention and split thickness skin grafts are mostly performed by oculoplastic surgeons, whereas regional or free flaps are mostly performed by ENT surgeons. Cerebrospinal fluid leakage is the most common intraoperative complication, encountered in 0 to 13 % of cases. The most common postoperative complications are ethmoid fistula and infection of the operative site, encountered in 0 to 50 % and 0 to 43 % of cases respectively. Orbital exenteration allows surgical resection of R0 tumors in 42.5 % to 97 % of cases. Overall survival following orbital exenteration is 83 % (50.5-97) and 65 % (37-92) at 1 and 5 years respectively. Identified risk factors for poor overall survival are: age, tumor histology (worse prognosis with choroidal melanoma, better prognosis with basal cell carcinoma), non-R0 surgical resection, locally advanced tumors (size>20mm, BCVA<20/400 and the presence of metastases at diagnosis). Recent studies have demonstrated favorable outcomes when managing locally advanced basal cell carcinoma, lacrimal gland cancer and conjunctival melanoma with targeted therapies or immunotherapies without performing orbital exenteration. CONCLUSION Orbital exenteration remains a major part of our therapeutic arsenal. Although orbital exenteration has failed to demonstrate any overall survival benefit, it allows satisfactory local control of the disease with an increasingly less invasive procedure. The development of targeted therapies and immunotherapies may change our therapeutic decisions in the future.
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Affiliation(s)
- A Martel
- Service d'ophtalmologie, centre hospitalier universitaire de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
| | - M Hamedani
- Département d'oculoplastie, hôpital ophtalmique Jules Gonin, Lausanne, Suisse
| | - J Lagier
- Service d'ophtalmologie, centre hospitalier universitaire de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - C Bertolotto
- Université Nice Côte d'Azur, Inserm, C3M, 151, route Saint-Antoine de Ginestière, 06204 Nice, France
| | - L Gastaud
- Service d'oncologie médicale, centre Antoine Lacassagne, 06204 Nice, France
| | - G Poissonnet
- Service de chirurgie oncologique cervico-faciale, centre Antoine Lacassagne, 06189 Nice, France
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Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, Hoenigl M, Jensen HE, Lagrou K, Lewis RE, Mellinghoff SC, Mer M, Pana ZD, Seidel D, Sheppard DC, Wahba R, Akova M, Alanio A, Al-Hatmi AMS, Arikan-Akdagli S, Badali H, Ben-Ami R, Bonifaz A, Bretagne S, Castagnola E, Chayakulkeeree M, Colombo AL, Corzo-León DE, Drgona L, Groll AH, Guinea J, Heussel CP, Ibrahim AS, Kanj SS, Klimko N, Lackner M, Lamoth F, Lanternier F, Lass-Floerl C, Lee DG, Lehrnbecher T, Lmimouni BE, Mares M, Maschmeyer G, Meis JF, Meletiadis J, Morrissey CO, Nucci M, Oladele R, Pagano L, Pasqualotto A, Patel A, Racil Z, Richardson M, Roilides E, Ruhnke M, Seyedmousavi S, Sidharthan N, Singh N, Sinko J, Skiada A, Slavin M, Soman R, Spellberg B, Steinbach W, Tan BH, Ullmann AJ, Vehreschild JJ, Vehreschild MJGT, Walsh TJ, White PL, Wiederhold NP, Zaoutis T, Chakrabarti A. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. THE LANCET. INFECTIOUS DISEASES 2019; 19:e405-e421. [PMID: 31699664 PMCID: PMC8559573 DOI: 10.1016/s1473-3099(19)30312-3] [Citation(s) in RCA: 856] [Impact Index Per Article: 171.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/10/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
Abstract
Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
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Affiliation(s)
- Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany.
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Dorothee Arenz
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, and the Department of Infectious Diseases, Westmead Hospital, School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Eric Dannaoui
- Université Paris-Descartes, Faculté de Médecine, APHP, Hôpital Européen Georges Pompidou, Unité de Parasitologie-Mycologie, Service de Microbiologie, Paris, France
| | - Bruno Hochhegger
- Radiology, Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, Brazil; Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
| | - Henrik E Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven and Clinical Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Russell E Lewis
- Infectious Diseases Clinic, Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Mervyn Mer
- Divisions of Critical Care and Pulmonology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Zoi D Pana
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece
| | - Danila Seidel
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Donald C Sheppard
- Division of Infectious Diseases, Department of Medicine, Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Roger Wahba
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alexandre Alanio
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, CNRS UMR2000, Parasitology-Mycology Laboratory, Lariboisière, Saint-Louis, Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Abdullah M S Al-Hatmi
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands; Centre of Expertise in Mycology RadboudUMC/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; Ministry of Health, Directorate General of Health Services, Ibri, Oman
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University School of Medicine, Sıhhiye Ankara, Turkey
| | - Hamid Badali
- Department of Medical Mycology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ronen Ben-Ami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Tel Aviv Medical Center, Tel- Aviv, Israel
| | - Alexandro Bonifaz
- Dermatology Service & Mycology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Stéphane Bretagne
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, CNRS UMR2000, Parasitology-Mycology Laboratory, Lariboisière, Saint-Louis, Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Elio Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Methee Chayakulkeeree
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arnaldo L Colombo
- Special Mycology Laboratory, Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dora E Corzo-León
- Department of Epidemiology and Infectious Diseases, Hospital General Dr Manuel Gea González, Mexico City, Mexico; Medical Mycology and Fungal Immunology/Wellcome Trust Strategic Award Program, Aberdeen Fungal Group, University of Aberdeen, King's College, Aberdeen, UK
| | - Lubos Drgona
- Oncohematology Clinic, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Andreas H Groll
- InfectiousDisease Research Program, Department of Paediatric Hematology/Oncology and Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany
| | - Jesus Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación v Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Claus-Peter Heussel
- Diagnostic and Interventional Radiology, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Ashraf S Ibrahim
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nikolay Klimko
- Department of Clinical Mycology, Allergology and Immunology, North Western State Medical University, St Petersburg, Russia
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University Innsbruck, Innsbruck, Austria
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine and Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland; Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Fanny Lanternier
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
| | - Cornelia Lass-Floerl
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University Innsbruck, Innsbruck, Austria
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Korea
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Badre E Lmimouni
- School of Medicine and Pharmacy, University Mohammed the fifth, Hay Riad, Rabat, Morocco
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iaşi, Romania
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rita Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Yaba, Lagos, Nigeria; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Livio Pagano
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli -IRCCS- Universita Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Pasqualotto
- Federal University of Health Sciences of Porto Alegre, Hospital Dom Vicente Scherer, Porto Alegre, Brazil
| | - Atul Patel
- Infectious Diseases Clinic, Vedanta Institute of Medical Sciences, Navarangpura, Ahmeddabad, India
| | - Zdenek Racil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Malcolm Richardson
- UK NHS Mycology Reference Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece
| | - Markus Ruhnke
- Hämatologie & Internistische Onkologie, Lukas-Krankenhaus Bünde, Onkologische Ambulanz, Bünde, Germany
| | - Seyedmojtaba Seyedmousavi
- Department of Medical Mycology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Center of Expertise in Microbiology, Infection Biology and Antimicrobial Pharmacology, Tehran, Iran; Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Neeraj Sidharthan
- Department of Hemato Oncology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham University, Kochi, India
| | - Nina Singh
- Division of Infectious Diseases, University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System, Infectious Diseases Section, University of Pittsburgh, Pittsburgh, PA, USA
| | - János Sinko
- Infectious Diseases Unit, Szent Istvan and Szent Laszlo Hospital, Budapest, Hungary
| | - Anna Skiada
- Department of Infectious Diseases, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Monica Slavin
- University of Melbourne, Melbourne, VIC, Australia; The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Melbourne, VIC, Australia
| | - Rajeev Soman
- P D Hinduja Hospital & Medical Research Centre, Department of Medicine, Veer Sarvarkar Marg, Mumbai, India
| | - Brad Spellberg
- Los Angeles County and University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - William Steinbach
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapur, Singapore
| | - Andrew J Ullmann
- Department for Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Jörg J Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas J Walsh
- Departments of Medicine, Pediatrics, Microbiology & Immunology, Weill Cornell Medicine, and New York Presbyterian Hospital, New York City, NY, USA
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, UHW, Heath Park, Cardiff, UK
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | - Theoklis Zaoutis
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Invasive Fungal Sinusitis: Risk Factors for Visual Acuity Outcomes and Mortality. Ophthalmic Plast Reconstr Surg 2019; 35:535-542. [DOI: 10.1097/iop.0000000000001357] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Srinivasarao DA, Lohiya G, Katti DS. Fundamentals, challenges, and nanomedicine‐based solutions for ocular diseases. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2018; 11:e1548. [DOI: 10.1002/wnan.1548] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/21/2018] [Accepted: 10/28/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Dadi A. Srinivasarao
- Department of Biological Sciences and Bioengineering Indian Institute of Technology Kanpur Kanpur India
| | - Garima Lohiya
- Department of Biological Sciences and Bioengineering Indian Institute of Technology Kanpur Kanpur India
| | - Dhirendra S. Katti
- Department of Biological Sciences and Bioengineering Indian Institute of Technology Kanpur Kanpur India
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