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Abraham AP, Manesh A, Regi S, Michael JS, Kumar RH, Thomas M, Cherian LM, Varghese L, Kurien R, Moorthy RK, Nair BR, Rajshekhar V, Rupa V. Pott's puffy tumor: An unusual complication of rhino-orbito-cerebral mucormycosis. World Neurosurg X 2024; 23:100387. [PMID: 38746040 PMCID: PMC11091675 DOI: 10.1016/j.wnsx.2024.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
Objective To describe clinicoradiological features and surgical outcomes in a series of nine patients with rhino-orbito-cerebral mucormycosis (ROCM) who presented with Pott's puffy tumor (ROCM-PPT). Methods The records of nine patients with ROCM-PPT seen between March 2020 and December 2021 were analysed. Clinical features, radiology, histopathology, operative findings, management and outcome were noted. Frontal sinus pneumatisation and outflow tract configuration was compared between patients and controls with ROCM and no PPT. Results ROCM-PPT was diagnosed in 9 of 284 (3.2 %) patients with ROCM seen during the study period. There were six (66.7 %) males and the median age was 54 (IQR 46-60) years. Eight (88.9 %) patients had diabetes mellitus and seven (77.8 %) had been COVID-19 positive. Radiological features of osteomyelitis, subperiosteal abscess formation and dural enhancement were seen in all patients. No significant differences in pneumatisation or frontal sinus outflow tract configuration were noted between patients and controls. All patients underwent a craniectomy with frontal bone debridement and frontal sinus exteriorisation. All patients were treated with anti-fungal agents for several months. All patients had symptomatic improvement at a median follow-up of 21 (IQR 18-23) months. Repeat CT/MRI scans showed disease regression/resolution in six out of eight (75 %) patients with follow-up imaging, and stable disease in two others. Conclusions ROCM-PPT is a rare, delayed complication of mucormycosis that was seen in larger numbers during the recent COVID-19 pandemic. Aggressive debridement of osteomyelitic bone and antifungal therapy results in a good outcome.
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Affiliation(s)
- Ananth P. Abraham
- Departments of Neurological Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Abi Manesh
- Departments of Infectious Diseases, Christian Medical College Vellore, Tamil Nadu, India
| | - Soumya Regi
- Departments of Radiology, Christian Medical College Vellore, Tamil Nadu, India
| | - Joy S. Michael
- Departments of Microbiology, Christian Medical College Vellore, Tamil Nadu, India
| | - R Hemanth Kumar
- Departments of Pathology, Christian Medical College Vellore, Tamil Nadu, India
| | - Meera Thomas
- Departments of Pathology, Christian Medical College Vellore, Tamil Nadu, India
| | - Lisa Mary Cherian
- Departments of Otorhinolaryngology, Christian Medical College Vellore, Tamil Nadu, India
| | - Lalee Varghese
- Departments of Otorhinolaryngology, Christian Medical College Vellore, Tamil Nadu, India
| | - Regi Kurien
- Departments of Otorhinolaryngology, Christian Medical College Vellore, Tamil Nadu, India
| | - Ranjith K. Moorthy
- Departments of Neurological Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Bijesh Ravindran Nair
- Departments of Neurological Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Vedantam Rajshekhar
- Departments of Neurological Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Vedantam Rupa
- Departments of Otorhinolaryngology, Christian Medical College Vellore, Tamil Nadu, India
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Ambika S, Lakshmi P. Infectious optic neuropathy (ION), how to recognise it and manage it. Eye (Lond) 2024:10.1038/s41433-024-03152-8. [PMID: 38831116 DOI: 10.1038/s41433-024-03152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024] Open
Abstract
Optic neuropathy can be of infectious or non-infectious/idiopathic aetiology. Many infectious organisms can cause optic neuropathy that can be of varied presentation including papillitis, retrobulbar optic neuritis, neuroretinitis, and optic perineuritis. Detailed history, ocular, systemic/neurologic examination along with appropriate laboratory evaluation can help clinicians to identify the infectious agent causing optic neuropathy. In spite of recent advanced techniques in serological testing and molecular diagnostics like polymerase chain reaction (PCR), the identification of these pathogens is still a diagnostic challenge. It is ideal to have an infectious disease (ID) consultant in the management team, as most of these infections are multisystem involving diseases. Most infectious agents can be effectively treated with specific antibiotics, with or without corticosteroid therapy, but visual recovery is highly variable and depends entirely on early diagnosis of the causative agent. This review article will provide an overview of common pathogens involved in ION and will describe their management paradigms.
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Affiliation(s)
- Selvakumar Ambika
- Department of Neuro-Ophthalmology, Sankara Nethralaya - A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India.
| | - Padma Lakshmi
- Department of Neuro-Ophthalmology, Sankara Nethralaya - A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India
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Kordjazi M, Bazgir N, Eftekharian K, Farajpour M, Dilmaghani NA. Manifestations of Mucormycosis and Its Complications in COVID-19 Patients: A Case Series Study. EAR, NOSE & THROAT JOURNAL 2024; 103:145S-152S. [PMID: 36583239 PMCID: PMC9805989 DOI: 10.1177/01455613221143859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Mucormycosis is an opportunistic fungal disease that affects immunocompromised patients. With the advent of SARS-CoV-2, this opportunistic disease has increased. METHODS A case series of 47 patients with COVID-19 associated mucormycosis have been analyzed. Demographic information, signs, symptoms, laboratory investigations, imaging studies, and their association with ICU admission and 30-day mortality were assessed. RESULTS Total number of 47 consecutive rhino-orbital cerebral mucormycosis (ROCM) cases were analyzed. Periorbital swelling was the most common sign among patients. Majority of cases had diabetes. All patients received liposomal Amphotericin B. Debridement was performed for all cases. CONCLUSIONS SARS-CoV-2 increases the susceptibility to mucormycosis infection in various ways. Uncontrolled level of HbA1c in all patients, even non-diabetic individuals, indicates hyperglycemia over the past three months. Diabetes, orbital exenteration, ptosis, periorbital swelling, DKA, LOC, brain involvement, and mechanical ventilation all correlated with a higher rate of ICU admission and 30-day mortality. In addition, a higher white blood cell count is related to the higher probability of ICU admission. While considering all of the inflammatory laboratory data and HbA1c could help predict 30-day mortality.
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Affiliation(s)
- Mohammadsmaeil Kordjazi
- Departmentof Otorhinolaryngology,
Loghman Hakim Educational Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Narges Bazgir
- School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Kourosh Eftekharian
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Mostafa Farajpour
- Depatement of general surgery, Arak University of Medical
Sciences, Arak, Iran
| | - Nader Akbari Dilmaghani
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
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4
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Bothra N, Priya Y, Rincy D, Ali MJ. Early trends of secondary acquired nasolacrimal duct obstruction in COVID-19 associated sino-orbital mucormycosis: SALDO update study (SUP) - Paper IV. Am J Ophthalmol Case Rep 2024; 34:102024. [PMID: 38426069 PMCID: PMC10904229 DOI: 10.1016/j.ajoc.2024.102024] [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: 12/13/2023] [Revised: 02/02/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
Purpose To study the emerging trend of development of secondary acquired nasolacrimal duct obstruction (SALDO) in the cases treated for rhino-orbito-cerebral mucormycosis (ROCM). Observations Prospective, interventional case series of five patients who developed SALDO post-surgical and medical management of ROCM. The mean age was 45.4 years (range: 40-62 years), all five being males. Right lacrimal drainage pathways was involved slightly more than the left (right:left = 3:2). Epiphora and discharge were the main presenting features. All five patients were treated with extensive debridement of the nose, sinuses, orbit and cerebral involvement as needed followed by medical management for ROCM. CT- Dacryocystography for all 5 patients showed obstruction at the lower end of the nasolacrimal duct. The patients underwent external dacryocystorhinostomy with mitomycin-C with or without intubation with good anatomical and functional outcomes at 6 months follow-up. Conclusions and importance The present series highlights the possible etiology of development of SALDO in cases treated for ROCM, its management and discusses the role of Computed Tomography Dacryocystography (CT-DCG) in understanding the pathophysiology of the development of SALDO along with delineating the spatial relationship of the lacrimal drainage system with the surrounding structures.
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Affiliation(s)
- Nandini Bothra
- Govindram Seksaria Institute of Dacryology, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Yamini Priya
- St John's Medical College Hospital, Bangaluru, 560032, India
| | - D. Rincy
- St John's Medical College Hospital, Bangaluru, 560032, India
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V.Prasad Eye Institute, Hyderabad, 500034, India
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5
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Seidel D, Sal E, Nacov JA, Cornely OA, Kurzai O. [Mucormycosis in the time of COVID-19: risks and challenges]. Dtsch Med Wochenschr 2024; 149:569-578. [PMID: 38657596 DOI: 10.1055/a-2139-3902] [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: 04/26/2024]
Abstract
The first patients positive for SARS-CoV-2 were registered in December 2019. In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic, the beginning of a worldwide health crisis that revealed numerous medical challenges for healthcare systems and pandemic emergency strategies.Among these challenges, mucormycosis, a typically rare fungal infection, gained global attention. With an average global incidence of about 2 per 1 million people, mucormycosis is considered a very rare disease, an opportunistic infection mostly affecting the lungs or skin and soft tissues in immunocompromised patients. Poorly controlled diabetes mellitus is one of the leading risk factors for rhino-orbital mucormycosis. Countries with a high prevalence of diabetes and limited healthcare resources have higher mucormycosis rates, with India and Pakistan being among the nations with particularly high incidences.During the second wave of the COVID-19 pandemic in India, mucormycosis rates surged dramatically within a few weeks, with over 47,500 cases of COVID-19-associated mucormycosis (CAM) reported between May and August 2021. Mucormycosis is characterized by a high mortality rate of up to 90%, especially when the diagnosis is delayed, and treatment commences late. There were concerns about a potentially global threat.In this article, we explore the risk factors and mechanisms leading to this viral-fungal coinfection. We present global distribution patterns, clinical presentation, and challenges in the diagnosis and treatment of COVID-19-associated mucormycosis.
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6
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George J, Patil D, Juneja M, Singh A. Mucormycotic osteomyelitis of the mandible. INDIAN J PATHOL MICR 2024; 67:477-478. [PMID: 38391329 DOI: 10.4103/ijpm.ijpm_792_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2024] Open
Affiliation(s)
- Jiji George
- Department of Oral and Maxillofacial Pathology, BBD College of Dental Sciences, Lucknow, Uttar Pradesh, India
| | - Dakshayani Patil
- Department of Oral and Maxillofacial Pathology, BBD College of Dental Sciences, Lucknow, Uttar Pradesh, India
| | - Manish Juneja
- Department of General Dentistry, Practicing General Dentist and Oral Pathologist, Ashley Boulevard, New Bedford, MA, United States of America
| | - Ankita Singh
- Department of Oral and Maxillofacial Pathology, BBD College of Dental Sciences, Lucknow, Uttar Pradesh, India
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7
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Kusumesh R, Singh V, Sinha S, Ali MS, Mishra SK, Ambasta A, Prakash V, Sinha P, Sinha BP, Priyadarshi RN. Risk factors and clinical presentation of rhino-orbital mucormycosis: Lesson learnt during Covid pandemic. J Family Med Prim Care 2024; 13:1354-1361. [PMID: 38827672 PMCID: PMC11142005 DOI: 10.4103/jfmpc.jfmpc_1259_23] [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: 08/01/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 06/04/2024] Open
Abstract
Aim To analyze the potential predisposing factors and clinical presentation of mucormycosis in patients with COVID-19. Material and Methods Medical records of 141 patients with COVID-19-associated mucormycosis (CAM) treated at a tertiary care center in Bihar were reviewed. The predisposing factors, clinical features, and imaging findings of mucormycosis were analyzed. Results The median age was 48 years (IQR, 43-60). A total of 58 patients developed concurrent CAM and 83 post-CAM. The median interval between COVID-19 and onset of CAM symptoms was 15 days (IQR, 9-16). A total of 80 patients received at-home treatment for COVID-19, and 73 had mild-to-moderate disease. While 61 patients received in-hospital treatment, 57 had severe disease. At presentation, 131 patients had hyperglycemia: 64 type 2 diabetes mellitus (DM) and 67 new-onset DM. The history of glucocorticoid use for COVID-19 was present in 125 patients; 47% were administered at home without monitoring plasma glucose. The common presenting features were toothache, periocular or facial pain, and edema. Rhino-orbital mucormycosis was the most common. Imaging revealed rhinosinusitis in all patients, including pansinusitis (68%), pterygopalatine fossa involvement (21%), cavernous sinus thrombosis (38%), brain abscess (8%), and infarct (4%). All patients received intravenous liposomal amphotericin B, and surgical debridement was performed in 113. Conclusion COVID-19 patients with hyperglycemia are at risk of developing CAM, irrespective of the severity. Timely recognition of symptoms and prompt initiation of therapy by primary healthcare physicians are imperative for enhancing outcomes. Additionally, glucocorticoid overuse should be avoided, and close monitoring for hyperglycemia development is warranted.
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Affiliation(s)
- Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vivek Singh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shivani Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Mobashir S. Ali
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sarita K. Mishra
- Department of Otolaryngology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Ambasta
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ved Prakash
- Department of Endocrinology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Pravek Sinha
- Northern Command Hospital, Armed Forces Medical College, Pune, Maharashtra, India
| | - Bibhuti P. Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Rajeev N. Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
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8
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Veisi A, Aletaha M, Abolhosseini M, Ownagh V, Fekri S, Feizi M, Amoushahi Khouzani S, Najafi M. Ophthalmic presentation and outcomes of rhino-orbito-cerebral mucormycosis during the COVID-19 pandemic: An 18-month follow-up report. J Fr Ophtalmol 2024; 47:104139. [PMID: 38696866 DOI: 10.1016/j.jfo.2024.104139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE To investigate the long-term outcomes of COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM) patients. METHODS Retrospective, observational study including all COVID-19 patients who developed ROCM and were referred to our oculoplastic clinic. RESULTS Twenty-one patients with COVID-19-associated ROCM were included in this study. Twelve (57.1%) individuals were female with a mean age of 50.7±7.6 years (range 33-59), and nine (38.1%) were male with a mean age of 58.7±14.4 years (range 37-82). Corticosteroids were used in 85.7% of patients, and three patients received no systemic corticosteroids; 76.2% were diabetic and two of these developed new-onset diabetes mellitus (DM) after receiving corticosteroids during their treatment course. The average interval between COVID-19 and the development of ROCM in our subjects was 18.6 days (range 8-46 days). In our series of patients, decreasing vision, proptosis, and periorbital edema constituted the most prevalent presentation, seen in 52.4% of subjects. Endoscopic paranasal sinus debridement was performed a mean of 3.4 times in 95.2%, abscess drainage in one, and orbital exenteration in three (14.2%) patients. Orbital apex and bilateral paranasal sinus involvement were significantly associated with higher mortality, and the overall 18-month survival rate was 52.3%. CONCLUSION Based upon common factors among the COVID-19-associated ROCM patients, we presume that DM and drug-induced immunosuppression are two main factors, which may lead to a higher rate of ROCM infection in areas where fungal spores are more likely to be present, such as hospitals.
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Affiliation(s)
- A Veisi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Aletaha
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Abolhosseini
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - V Ownagh
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - S Fekri
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Feizi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Amoushahi Khouzani
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Najafi
- Ophthalmic Research Center, Research Institite for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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9
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Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS, Tayade A, Bhandari S, Gella V, Savio J, Madan S, Hallur V, Maturu VN, Srinivasan A, Sethuraman N, Singh Sibia RP, Pujari S, Mehta R, Singhal T, Saxena P, Gupta V, Nagvekar V, Prayag P, Patel D, Xess I, Savaj P, Sehgal IS, Panda N, Rajagopal GD, Parwani RS, Patel K, Deshmukh A, Vyas A, Gandra RR, Sistla SK, Padaki PA, Ramar D, Sarkar S, Rachagulla B, Vallandaramam P, Premachandran KP, Pawar S, Gugale P, Hosamani P, Dutt SN, Nair S, Kalpakkam H, Badhwar S, Kompella KK, Singla N, Navlakhe M, Prayag A, Singh G, Dhakecha P, Chakrabarti A. Risk factors, mortality, and predictors of survival in COVID-19-associated pulmonary mucormycosis: a multicentre retrospective study from India. Clin Microbiol Infect 2024; 30:368-374. [PMID: 38081413 DOI: 10.1016/j.cmi.2023.12.006] [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: 10/05/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To compare COVID-19-associated pulmonary mucormycosis (CAPM) with COVID-19-associated rhino-orbital mucormycosis (CAROM), ascertain factors associated with CAPM among patients with COVID-19, and identify factors associated with 12-week mortality in CAPM. METHODS We performed a retrospective multicentre cohort study. All study participants had COVID-19. We enrolled CAPM, CAROM, and COVID-19 subjects without mucormycosis (controls; age-matched). We collected information on demography, predisposing factors, and details of COVID-19 illness. Univariable analysis was used to compare CAPM and CAROM. We used multivariable logistic regression to evaluate factors associated with CAPM (with hypoxemia during COVID-19 as the primary exposure) and at 12-week mortality. RESULTS We included 1724 cases (CAPM [n = 122], CAROM [n = 1602]) and 3911 controls. Male sex, renal transplantation, multimorbidity, neutrophil-lymphocyte ratio, intensive care admission, and cumulative glucocorticoid dose for COVID-19 were significantly higher in CAPM than in CAROM. On multivariable analysis, COVID-19-related hypoxemia (aOR, 2.384; 95% CI, 1.209-4.700), male sex, rural residence, diabetes mellitus, serum C-reactive protein, glucocorticoid, and zinc use during COVID-19 were independently associated with CAPM. CAPM reported a higher 12-week mortality than CAROM (56 of the 107 [52.3%] vs. 413 of the 1356 [30.5%]; p = 0.0001). Hypoxemia during COVID-19 (aOR [95% CI], 3.70 [1.34-10.25]) and Aspergillus co-infection (aOR [95% CI], 5.40 [1.23-23.64]) were independently associated with mortality in CAPM, whereas surgery was associated with better survival. DISCUSSION CAPM is a distinct entity with a higher mortality than CAROM. Hypoxemia during COVID-19 illness is associated with CAPM. COVID-19 hypoxemia and Aspergillus co-infection were associated with higher mortality in CAPM.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | - Deepak Thangaraju
- Department of Microbiology, Kovai Medical Center and Hospital, Coimbatore, India
| | | | - Atul K Patel
- Department of Infectious Diseases, Sterling Hospital, Ahmedabad, India
| | | | - Ashwini Tayade
- Department of Infectious Diseases, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Sudhir Bhandari
- Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Vishwanath Gella
- Department of Pulmonary Medicine, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Jayanthi Savio
- Department of Microbiology, St. John's Medical College and Hospital, Bangalore, Karnataka, India
| | - Surabhi Madan
- Department of Infectious Diseases, Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | - Vinaykumar Hallur
- Department of Microbiology, All India Institute of Medical Science Bhubaneswar, Odisha, India
| | | | - Arjun Srinivasan
- Department of Pulmonary Medicine, Royal Care Hospital, Coimbatore, India
| | | | | | - Sanjay Pujari
- Department of HIV Medicine and Infectious Diseases, Poona Hospital and Research Centre, Pune, Maharashtra, India
| | - Ravindra Mehta
- Department of Pulmonary Medicine, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Tanu Singhal
- Department of Infectious Diseases, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Puneet Saxena
- Department of Pulmonary Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College, Chandigarh, India
| | - Vasant Nagvekar
- Department of Infectious Diseases, Global Hospital, Mumbai, India
| | - Parikshit Prayag
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India
| | - Dharmesh Patel
- Department of Pulmonary Medicine, City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pratik Savaj
- Department of Infectious Diseases, Institute of Infectious Disease and Critical Care Hospital, Surat, Gujarat, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Panda
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Kamlesh Patel
- Department of Microbiology and Infection Prevention & Control, Sterling Hospital, Ahmedabad, India
| | - Anuradha Deshmukh
- Department of Microbiology, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Aruna Vyas
- Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Raghava Rao Gandra
- Department of Pulmonary Medicine, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Srinivas Kishore Sistla
- Department of Otorhinolaryngology, Asian Institute of Gastroenterology, Hyderabad, Telengana, India
| | - Priyadarshini A Padaki
- Department of Microbiology, St. John's Medical College and Hospital, Bangalore, Karnataka, India
| | - Dharshni Ramar
- Clinical Associate, Department of Research, Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | - Saurav Sarkar
- Department of Otorhinolaryngology, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Bharani Rachagulla
- Department of Pulmonary Medicine, Yashoda Hospitals, Somajiguda, Hyderabad, India
| | | | | | - Sunil Pawar
- Department of Internal Medicine, Government Medical College, Patiala, Punjab, India
| | - Piyush Gugale
- Department of HIV Medicine and Infectious Diseases, Poona Hospital and Research Centre, Pune, Maharashtra, India
| | - Pradeep Hosamani
- Department of Otorhinolaryngology, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Sunil Narayan Dutt
- Department of Otorhinolaryngology, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Satish Nair
- Department of Otorhinolaryngology, Apollo Hospitals, Bengaluru, Karnataka, India
| | | | - Sanjiv Badhwar
- Department of Otorhinolaryngology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Kiran Kumar Kompella
- Department of Internal Medicine and Infectious Diseases, Army Hospital (Research and Referral), New Delhi, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College, Chandigarh, India
| | - Milind Navlakhe
- Department of Otorhinolaryngology, Global Hospital, Mumbai, India
| | - Amrita Prayag
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Poorvesh Dhakecha
- Clinical Associate, Department of Research, Institute of Infectious Disease and Critical Care Hospital, Surat, Gujarat, India
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10
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Jeican II, Horhat DI, Dumitru M, Florea A, Barbu-Tudoran L, Gheban BA, Anton V, Toader C, Aluaș M, Siserman CV, Balica N, Vrînceanu D, Albu S. COVID-19-Associated Rhino-Orbital Mucormycosis: Histological and Electron Microscopy Characteristics. Diagnostics (Basel) 2024; 14:429. [PMID: 38396469 PMCID: PMC10887990 DOI: 10.3390/diagnostics14040429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
COVID-19-associated rhino-orbital mucormycosis has become a new clinical entity. This study's aim was to evaluate the histopathological and ultramicroscopic morphological aspects of this fungal infection. This was an observational retrospective study on eight patients from three tertiary centers in Romania. The tissue samples collected during functional endoscopic sinus surgery were studied through histopathological examination, scanning electron microscopy, and transmission electron microscopy. In the histopathological examination, the morphological aspects characteristic of mucormycosis in all cases were identified: wide aseptate hyphae with right-angle ramifications, which invade blood vessels. One case presented perineural invasion into the perineural lymphatics. And in another case, mucormycosis-aspergillosis fungal coinfection was identified. Through scanning electron microscopy, long hyphae on the surface of the mucosa surrounded by cells belonging to the local immune system were identified in all samples, and bacterial biofilms were identified in half of the samples. Through transmission electron microscopy, aseptate hyphae and bacterial elements were identified in the majority of the samples. Rhino-orbital-cerebral mucormycosis associated with COVID-19 produces nasal sinus dysbiosis, which favors the appearance of bacterial biofilms. The way in which the infection develops depends on the interaction of the fungi with cells of the immune system.
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Affiliation(s)
- Ionuț Isaia Jeican
- Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Delia Ioana Horhat
- Department of Ear-Nose-Throat, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.I.H.); (N.B.)
| | - Mihai Dumitru
- Department of Ear-Nose-Throat, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania; (M.D.); (D.V.)
| | - Adrian Florea
- Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Lucian Barbu-Tudoran
- Electron Microscopy Laboratory Prof. C. Crăciun, Faculty of Biology and Geology, Babes-Bolyai University, 400006 Cluj-Napoca, Romania;
- Electron Microscopy Integrated Laboratory, National Institute for R&D of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania
| | - Bogdan-Alexandru Gheban
- Department of Histology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
- Department of Pathology, Emergency Clinical County Hospital, 400347 Cluj-Napoca, Romania
| | - Vlad Anton
- Department of Medical Biochemistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Corneliu Toader
- Clinic of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 041914 Bucharest, Romania;
| | - Maria Aluaș
- Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Costel Vasile Siserman
- Institute of Legal Medicine, 400006 Cluj-Napoca, Romania;
- Department of Legal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Nicolae Balica
- Department of Ear-Nose-Throat, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.I.H.); (N.B.)
| | - Daniela Vrînceanu
- Department of Ear-Nose-Throat, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania; (M.D.); (D.V.)
| | - Silviu Albu
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania;
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11
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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: 0] [Impact Index Per Article: 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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12
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Erami M, Raiesi O, Momen-Heravi M, Mirhendi H, Aboutalebian S, Getso MI, Matini AH, Ahsaniarani AH, Ganjizadeh M, Hassani Josheghani H, Amiri S, Pakzad R, Hashemi SJ. COVID-19 associated mucormycosis (CAM) in Kashan, Iran: clinical presentations, risk factors, management, and outcomes. Infect Dis (Lond) 2024; 56:81-90. [PMID: 37816067 DOI: 10.1080/23744235.2023.2267669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND This study aimed to estimate the disease burden and describe the clinical presentation, risk factors, and outcome of CAM in a single centre in Iran. METHODS A case of mucormycosis was defined as one that had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological and molecular examination. RESULTS We report 30 cases of COVID-19 associated mucormycosis (CAM). The results of this study showed the affected age group in the range of 40-79 years (median = 65.5; IQR = 5) with women (16/30, 53%) affected more than men (14/30, 47%). Among the fungi recovered, Rhizopus oryzae had the highest frequency (79%). Out of the 30 patients, 28 (93%) patients were diabetic with 24 (80%) patients having other co-morbidities. Headache followed by retro-orbital pain, proptosis/ptosis and rapid diminution of vision was a common sequence of symptoms reported by the majority of cases. Use of mechanical ventilation (58% vs. 6%, p = 0.003), O2 required (92% vs. 50%, p = 0.024), and development of renal dysfunction during hospital stay (17% vs. 0%, p = 0.041) was significantly higher in non-survivors than survivors. Temperature (C°), PR (pulse rate), mean levels of serum creatinine, BUN, troponin, and neutrophils were significantly higher in non-survivors (p < 0.05). Besides, Albumin and PO2 were also significantly higher in survivors than non-survivors. CONCLUSION Despite medical and surgical treatment, the mortality rate among CAM patients is still high. Thus, concerted efforts of revamping surveillance, diagnosis and management, along with public awareness and patient education, are the requisites for managing COVID-19 and mucormycosis.
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Affiliation(s)
- Mahzad Erami
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Raiesi
- Department of Parasitology, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Head and Neck Surgery, Department, Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Ganjizadeh
- Kashan Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Sasan Amiri
- Roozbeh hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Ilam University of Medical Sciences, Ilam, Iran
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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13
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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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14
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Kurien R, Varghese L, Cherian LM, Inja RR, Thampi M, Chowdhary S, Bright RR, Abraham L, Panicker R, Rajendran N, Ganesan P, Sahu S, Irodi A, Manesh A, Peter J, Michael JS, Thomas M, Karuppusami R, Varghese GM, Rupa V. A Comparative Study of Acute Invasive Fungal Sinusitis During the First and Second Waves of the COVID-19 Pandemic. Indian J Otolaryngol Head Neck Surg 2024; 76:611-619. [PMID: 38440599 PMCID: PMC10909060 DOI: 10.1007/s12070-023-04226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 03/06/2024] Open
Abstract
We aimed to compare the demography, clinical profile, histopathology, fungal culture, radiology, surgery performed, medical therapy and outcomes of patients with acute invasive fungal sinusitis seen during the first and second waves of the COVID-19 pandemic by retrospectively reviewing their case records. Of 238 patients, 43(18.1%) presented during the first wave and 195(81.9%) during the second wave. Patients seen during the first wave were older (p = 0.04) and more likely to have visual impairment (p = 0.004), frozen eye (p = 0.012), altered sensorium (p = 0.007) and stage 3 disease (p = 0.03). Those seen during the second wave were more often COVID-19 positive and had newly diagnosed diabetes mellitus (p = 0.04)and stage 1 disease (p = 0.03). Most patients had a positive culture for Rhizopus species during both waves. Histopathology showed broad aseptate hyphae in all patients but angioinvasion was seen more often during the first wave (p = 0.04). The majority of patients were treated with endoscopic+/- open debridement followed by intravenous amphotericin B and oral posaconazole. While the overall survival rate was similar (first wave 65.1%; second wave 79%; p = 0.106), mortality after discharge was greater during the first wave (11.6% vs 1.5%; p = 0.001). Mortality was higher in patients with stage 3 disease (p = 0.003). Significant differences in clinical presentation, histopathology, radiological stage of disease and post-discharge survival were noted between the two waves of the COVID-19 pandemic, the causes for which were multi-factorial.
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Affiliation(s)
- Regi Kurien
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lalee Varghese
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lisa Mary Cherian
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Ranjeetha Racheal Inja
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Manu Thampi
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Stuti Chowdhary
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Rakesh R Bright
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Lisa Abraham
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Raga Panicker
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Nithya Rajendran
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
| | - Priya Ganesan
- Department of Emergency Medicine, Christian Medical College, Vellore, 632004 India
| | - Shalini Sahu
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632004 India
| | - Aparna Irodi
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632004 India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004 India
| | - Jayanthi Peter
- Department of Ophthalmology, Christian Medical College, Vellore, 632004 India
| | | | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, 632004 India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, 632002 India
| | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004 India
| | - Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004 Tamilnadu India
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15
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Kurup LR, Singh H, Sharma SB, Janakiram TN. Outcome of Total Surgical Debridement of Covid Associated Rhino-Orbito-Cerebral Mucormycosis Based on a New Surgical Staging System: A Cohort Study. Indian J Otolaryngol Head Neck Surg 2024; 76:298-308. [PMID: 38440527 PMCID: PMC10908694 DOI: 10.1007/s12070-023-04151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 03/06/2024] Open
Abstract
To propose a surgical staging system with management protocol for post-covid Rhino-orbito-cerebral mucormycosis (ROCM) with central skull base osteomyelitis. A prospective cohort study of a total of 193 post-covid ROCM patients was conducted between May 2021 and January 2022 at a tertiary care centre. Patients were assessed radiologically and staged from I to V. Follow up period was 16 months and the surgical outcome in terms of recurrent disease was assessed. A total of 193 patients (129 primary and 64 revision) were studied. Maxilla was found to be the epicenter of anterior disease (69.3%) and pterygoid wedge was noted to be the epicenter of posterior disease (85.6%). More than 65% of our patients, at the time of presentation, presented with involvement of the central skull base. Intracranial disease was noted in 13.9% of patients and the mortality rate was 6.2%. This staging system provides a systematic step-by-step protocol for the management of ROCM, with emphasis on meticulous disease clearance at the central skull base.
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16
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Png LH, Ng DHL, Teo NWY. Infectious disease for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:28-34. [PMID: 37997887 DOI: 10.1097/moo.0000000000000947] [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: 11/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the recent literature relating to viral, fungal and bacterial infections and their interactions within the sinonasal tract in the past 18 months. RECENT FINDINGS Coronavirus disease 2019 (COVID-19)-associated olfactory dysfunction (OD) is variant dependent. Magnetic resonance imaging studies have found greater olfactory cleft opacification and higher olfactory bulb volume in post-COVID-19 OD. Olfactory training remains the mainstay of treatment, while platelet-rich plasma injections and ultramicronized palmitoylethanolamide and luteolin combination oral supplementation have shown early promise.Consensus statements on paranasal sinus fungal balls and acute invasive fungal sinusitis have been released.Studies on the nasal microbiome have reported Staphylococcus and Corynebacterium as the most abundant genera, with higher levels of Staphylococcus and Corynebacterium being found in patients with chronic rhinosinusitis (CRS) and healthy individuals respectively. However, there is conflicting evidence on the significance of biodiversity of the nasal microbiome found in CRS versus healthy patients. SUMMARY While the peak of the COVID-19 pandemic is behind us, its sequelae continue to pose treatment challenges. Further studies in OD have implications in managing the condition, beyond those afflicted post-COVID-19 infection. Similarly, more research is needed in studying the nasal microbiome and its implications in the development and treatment of CRS.
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Affiliation(s)
- Lu Hui Png
- Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital, Singapore
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Dorothy Hui Lin Ng
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Neville Wei Yang Teo
- Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital, Singapore
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17
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Gullì SP, Hallur V, Kale P, Menezes GA, Russo A, Singla N. From Spores to Solutions: A Comprehensive Narrative Review on Mucormycosis. Diagnostics (Basel) 2024; 14:314. [PMID: 38337830 PMCID: PMC10855476 DOI: 10.3390/diagnostics14030314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Mucormycosis is an infrequent but fatal illness that mainly affects patients with uncontrolled diabetes mellitus, diabetic ketoacidosis, solid and hematologic neoplasms, organ transplantation, chronic steroid intake, prolonged neutropenia, iron overload states, neonatal prematurity, severe malnutrition, and HIV. Many cases were reported across the world recently following the COVID-19 pandemic. Recent research has led to a better understanding of the pathogenesis of the disease, and global guidelines are now available for managing this serious infection. Herein, we comprehensively review the etiological agents, pathogenesis, clinical presentations, diagnosis, and management of mucormycosis.
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Affiliation(s)
- Sara Palma Gullì
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.P.G.); (A.R.)
| | - Vinaykumar Hallur
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Pratibha Kale
- Department of Clinical Microbiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India;
| | - Godfred Antony Menezes
- Department of Medical Microbiology & Immunology, RAK College of Medical Sciences, Ras Al Khaimah P.O. Box 11172, United Arab Emirates;
| | - Alessandro Russo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.P.G.); (A.R.)
| | - Nidhi Singla
- Department of Microbiology, Government Medical College and Hospital, Chandigarh 160030, India;
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Nidhin Das K, Sharma V, Gupta D, Tiwari S, Elhence P, Jain V, Soni K, Goyal A. Predicting intracranial involvement: Unveiling perineural spread in COVID-19-associated mucormycosis, a novel phenomenon. Med Mycol 2024; 62:myad135. [PMID: 38130212 DOI: 10.1093/mmy/myad135] [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: 07/07/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
This study aimed to investigate the risk factors associated with intracranial involvement in COVID-19-associated mucormycosis (CAM) and to develop a nomogram model for predicting the risk of intracranial involvement, with a specific focus on perineural spread. An ambispective analysis was conducted on 275 CAM patients who received comprehensive treatment. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors, and a nomogram was created based on the results of the multivariable analysis. The performance of the nomogram was evaluated using a receiver operating characteristic (ROC) curve, and the discriminatory capacity was assessed using the area under the curve (AUC). The model's calibration was assessed through a calibration curve and the Hosmer Lemeshow test. In the results, the multivariable logistic regression analysis revealed that age (OR: 1.23, 95% CI 1.06-3.79), HbA1c (OR: 7.168, 95% CI 1.724-25.788), perineural spread (OR: 6.3, 95% CI 1.281-19.874), and the disease stage were independent risk factors for intracranial involvement in CAM. The developed nomogram demonstrated good discriminative capacity with an AUC of 0.821 (95% CI 0.713-0.909) as indicated by the ROC curve. The calibration curve showed that the nomogram was well-calibrated, and the Hosmer Lemeshow test yielded a P-value of 0.992, indicating a good fit for the model. In conclusion, this study found that CAM particularly exhibits perineural spread, which is a predictive factor for intracranial involvement. A nomogram model incorporating age, HbA1c, disease stage, and perineural spread was successfully developed for predicting intracranial involvement in CAM patients in both in-patient and out-patient settings.
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Affiliation(s)
- K Nidhin Das
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Vidhu Sharma
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Diksha Gupta
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Poonam Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Kapil Soni
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
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Sigera LSM, Denning DW. A Systematic Review of the Therapeutic Outcome of Mucormycosis. Open Forum Infect Dis 2024; 11:ofad704. [PMID: 38288347 PMCID: PMC10823420 DOI: 10.1093/ofid/ofad704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Background Mucormycosis is a potentially lethal mycosis. We reviewed peer-reviewed publications on mucormycosis to assess therapeutic outcomes. Methods A systematic literature search using the Ovid MEDLINE and EMBASE databases identified manuscripts describing human mucormycosis diagnosed according to European Organization for Research and Treatment of Cancer and the Mycoses Study Group criteria with therapeutic outcomes published from 2000 to 2022. Results In 126 articles, 10 335 patients were described, most from Asia (n = 6632, 66%). Diabetes was the most frequent underlying disease (n = 6188, 60%); 222 (2.1%) patients had no underlying diseases. The dominant clinical form was rhino-orbitocerebral (n = 7159, 69.3%), followed by pulmonary (n = 1062, 10.3%). Of 5364 patients with outcome data, amphotericin B monotherapy (n = 3749, mortality 31.5%) was most frequent, followed by amphotericin B + azole (n = 843, mortality 6.6%; P < .0001), amphotericin B followed by azole (n = 357, mortality 13.7%; P < .0001), posaconazole only (n = 250, mortality 17.2%; P < .0001), and isavuconazole only (n = 65, mortality 24.6%; P = .24). Duration and dose of antifungals varied widely. Documented outcomes from surgical resections in 149 patients found that 47 of 125 died (37.6%), compared with 16 of 24 (66.7%) patients who did not undergo surgery (P = .008). Conclusions Mucormycosis is more frequently reported in Asia than in Europe and is often linked to diabetes. Antifungal therapy, usually with surgery, is frequently effective for mucormycosis.
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Affiliation(s)
- L Shamithra M Sigera
- Manchester Fungal Infection Group, Core Technology Facility, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David W Denning
- Manchester Fungal Infection Group, Core Technology Facility, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Thornton CR, Davies GE, Dougherty L. Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker. Front Cell Infect Microbiol 2023; 13:1305662. [PMID: 38145040 PMCID: PMC10739493 DOI: 10.3389/fcimb.2023.1305662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Mucoromycosis is a highly aggressive angio-invasive disease of humans caused by fungi in the zygomycete order, Mucorales. While Rhizopus arrhizus is the principal agent of mucoromycosis, other Mucorales fungi including Apophysomyces, Cunninghamella, Lichtheimia, Mucor, Rhizomucor and Syncephalastrum are able to cause life-threatening rhino-orbital-cerebral, pulmonary, gastro-intestinal and necrotising cutaneous infections in humans. Diagnosis of the disease currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Mucorales-specific biomarkers of infection, and which allow point-of-care diagnosis of mucoromycosis. Here, we report the development of an IgG2b monoclonal antibody (mAb), TG11, which binds to extracellular polysaccharide (EPS) antigens of between 20 kDa and 250 kDa secreted during hyphal growth of Mucorales fungi. The mAb is Mucorales-specific and does not cross-react with other yeasts and molds of clinical importance including Aspergillus, Candida, Cryptococcus, Fusarium, Lomentospora and Scedosporium species. Using the mAb, we have developed a Competitive lateral-flow device that allows rapid (30 min) detection of the EPS biomarker in human serum and bronchoalveolar lavage (BAL), with a limit of detection (LOD) in human serum of ~100 ng/mL serum (~224.7 pmol/L serum). The LFD therefore provides a potential novel opportunity for detection of mucoromycosis caused by different Mucorales species.
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Affiliation(s)
- Christopher R. Thornton
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Genna E. Davies
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Laura Dougherty
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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21
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Thakur (Rai) N, Misra M, Misra S, Misra S, Shukla DK, Singh AK, Dheer Y, Jaiswal V, Rai N. Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India. J Diabetes Metab Disord 2023; 22:1459-1469. [PMID: 37975119 PMCID: PMC10638341 DOI: 10.1007/s40200-023-01269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/19/2023] [Indexed: 11/19/2023]
Abstract
Introduction Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors. Materials and methods An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done. Results 367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics. Conclusion Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.
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Affiliation(s)
- Neha Thakur (Rai)
- Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226010 Uttar Pradesh India
| | - Maitreyi Misra
- Intern, Department Of Surgery, TSM Medical College, Lucknow, Uttar Pradesh India
| | - Samir Misra
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | | | - Devesh Kumar Shukla
- Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226010 Uttar Pradesh India
| | - Arvind Kumar Singh
- Department of Social and Preventive Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Yadvendra Dheer
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | - Vaibhav Jaiswal
- Department of Trauma Surgery, KGMU, Lucknow, Uttar Pradesh India
| | - Narendra Rai
- Department of Paediatrics, Chandan Hospital, Lucknow, Uttar Pradesh India
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22
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Verma V, Sarkar D, Moharana B, Singh P, Noyadu R, Sharma B. Study of rhino-orbital-cerebral mucormycosis and its correlates during COVID-19 pandemic in a tertiary eye care institute of central India. Indian J Ophthalmol 2023; 71:3669-3676. [PMID: 37991302 PMCID: PMC10788766 DOI: 10.4103/ijo.ijo_356_23] [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: 02/05/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE To evaluate factors associated with the occurrence of ROCM in COVID-19 patients and to compare its related parameters and outcomes between active and recovered COVID-19 groups. METHODS A total of 35 patients of ROCM associated with COVID-19 (active and post-COVID-19) were included. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessments of ROCM-associated COVID-19 during the second wave of the COVID-19 pandemic. The demographic data, clinical parameters, and outcome were recorded on MS excel sheet, and various parameters were compared between active and recovered COVID-19 groups. RESULTS ROCM in recovered COVID-19 group was higher (57.1%) as compared to active COVID-19 (42.9%) (P = 1.00). High occurrence of ROCM was seen in those who had a history of hospitalization due to severity of COVID-19 (n 33, 94.28%), oxygen support (77.14), and received systemic steroids (82.9%). The most common comorbidity was diabetes mellitus (82.9%), and new-onset hyperglycemia was noticed in 17.1% of patients. Exenteration (28.6%) was performed in severe cases who had stage IV ROCM, bilateral, and CNS involvement (RR = 7.2, 95% CI: 2.91 to 18.00). The risk of globe exenteration was 1.35 (0.7-2.29) times higher in recovered COVID-19 group, and mortality was 1.76 (0.72-3.36) times higher in active COVID-19 group. CONCLUSION Monitored use of systemic steroids and the prompt management of hyperglycemia in COVID-19 patients are important factors for favorable outcomes with reference to globe salvage and life-saving in ROCM associated with COVID-19. Even recovered COVID-19 patients should be observed for persistent hyperglycemia and occurrence of ROCM.
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Affiliation(s)
- Vidhya Verma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepayan Sarkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bruttendu Moharana
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Priti Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Richa Noyadu
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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23
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Varghese L, Kurien R, Cherian LM, Rebekah G, Regi S, Selvaraj DSS, Abhilash KPP, Thomas M, Michael JS, Varghese GM, Rupa V. Optimizing Surgical Management of Acute Invasive Fungal Sinusitis. Turk Arch Otorhinolaryngol 2023; 61:175-182. [PMID: 38784956 PMCID: PMC11110089 DOI: 10.4274/tao.2024.2023-10-4] [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: 10/11/2023] [Accepted: 01/05/2024] [Indexed: 05/25/2024] Open
Abstract
Objective Early surgical debridement is vital for favorable outcomes in acute invasive fungal sinusitis (AIFS). Our study aimed to propose guidelines with tailored, conservative surgical procedures based on areas of involvement and evaluate their usefulness in avoiding repeated debridement. Methods This retrospective observational study was conducted on 150 AIFS patients operated on with the proposed surgical guidelines from May to June 2021 at a tertiary care hospital. Data including demography, comorbidities, surgical procedures, revision surgery, and outcome were collected and analyzed. Results All 150 patients underwent bilateral endoscopic sinonasal debridement. Among them, 108 patients (72%) had current or recent coronavirus disease (COVID) infection. Ninety-two patients (61.3%) required additional procedures based on disease extent. Twenty patients (15.4%) required revision debridement because of progressive or recurrent disease. Mean age of this group was 46.15 (standard deviation ±11.2) years with a strong male predominance (9:1). Seventeen had diabetes mellitus, 12 suffered from active COVID-19 infection and six had received corticosteroids. None of the 31 patients who had recovered from COVID-19 or had no comorbidities required revision surgery. Age, gender, and comorbidities were not significant predictors for revision surgery. Fourteen patients (70%) underwent second surgery within one month of primary surgery. Predominant disease locations were alveolus and palate (55% each), and in 80% the site was uninvolved at primary surgery. The most common revision procedure was inferior partial maxillectomy (60%). At follow-up, all were asymptomatic with no evidence of disease. Conclusion The proposed surgical guidelines for AIFS allow for adequate surgical debridement with preservation of optimum functional status. Low revision surgery rates and good outcomes with minimal morbidity validate its usefulness.
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Affiliation(s)
- Lalee Varghese
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Regi Kurien
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Lisa Mary Cherian
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Soumya Regi
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | | | | | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, India
| | | | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
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24
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Gupta R, Kalra P, Ramamurthy LB, Rath S. Thyroid Eye Disease and Its Association With Diabetes Mellitus: A Major Review. Ophthalmic Plast Reconstr Surg 2023; 39:S51-S64. [PMID: 38054986 DOI: 10.1097/iop.0000000000002449] [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: 12/07/2023]
Abstract
PURPOSE Thyroid eye disease (TED) associated with diabetes mellitus (DM) presents unique challenges. DM is a risk factor for TED. Standard management of TED with glucocorticoids (GC), orbital radiation, or teprotumumab can cause adverse events in poor glycemic control. The authors reviewed the literature on the relationship between TED and DM and the management of co-existing diseases. METHODS The authors searched PubMed with keywords "thyroid eye disease," "diabetes mellitus," and similar terms from 2013 to 2022. The authors included relevant studies after screening the abstracts. Additional references to the selected studies were included where applicable. Data were extracted from the final articles according to the preplanned outline of the review. RESULTS The initial search yielded 279 abstracts. The final review included 93 articles. TED and DM interact at multiple levels-genetic, immunologic, cellular, nutritional, and metabolic. Both DM and thyroid dysfunction exacerbate the morbidity caused by the other. Metabolic factors also affect the inflammatory pathway for TED. Patients with DM develop TED with greater frequency and severity, necessitating interventions for vision salvage. Agents (GC, teprotumumab, or radiation) used for TED are often unsuitable for treatment with DM, especially if there is poor glycemic control or diabetic retinopathy. There were no studies on using steroid-sparing agents in TED with DM. CONCLUSION TED and DM co-exist because of multiple intersections in the pathophysiology. Challenges in the treatment include increased TED severity and risk of hyperglycemia and retinopathy. Multidisciplinary teams best undertake treatment of TED with DM.
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Affiliation(s)
- Roshmi Gupta
- Orbit, Oculoplasty and Ocular Oncology, Trustwell Hospital, Bengaluru, Karnataka, India
| | - Pramila Kalra
- Department of Endocrinology, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Lakshmi B Ramamurthy
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Suryasnata Rath
- Ophthalmic Plastics, Orbit, and Ocular Oncology Services, Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, India
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25
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Dailey Garnes NJM, Kontoyiannis DP. Mucormycosis: update on clinical presentation, diagnosis, and treatment. Curr Opin Infect Dis 2023; 36:427-435. [PMID: 37732771 DOI: 10.1097/qco.0000000000000976] [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: 09/22/2023]
Abstract
PURPOSE OF REVIEW Mucormycosis (MCR) is a common opportunistic mold infection, and Mucorales were recently designated by WHO as priority pathogens. The interest in this infection has risen significantly since the major outbreak of MCR in the context of the COVID-19 pandemic, particularly in India. Herein, we summarize recently (last 24 months) published information regarding clinical aspects of MCR. RECENT FINDINGS The disease remains protean in its clinical presentation, difficult to diagnose, and challenging to treat. In 2021, cases of COVID-19-associated mucormycosis (CAM) exploded in India during COVID-19 and manifested primarily as sino-orbital or sino-cerebral disease. Its classic risk factors included the triad of COVID-19, uncontrolled diabetes mellitus and use of corticosteroids. Despite difficulties in the timely diagnosis of MCR, significant progress has been made with the use of molecular techniques in blood to assist with earlier diagnosis, which can facilitate earlier appropriate therapy and improve outcomes. In addition, advances have been made in the use of imaging to stage the disease, determining what types of multimodal therapy are required depending on staging, and tissue-based identification of Mucorales. SUMMARY Although the outlook for MCR has improved, effective new antifungals, risk stratification, and the optimal multimodality approaches remain an unmet need.
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Affiliation(s)
- Natalie J M Dailey Garnes
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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26
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Bhavana K, Vaidyanathan A, Haidry N, Bharti B, Kumar A, Shivhare P. A Novel Classification System for Oral Cavity Mucormycosis: a Hospital Based Cross-Sectional Study. J Maxillofac Oral Surg 2023; 22:1139-1147. [PMID: 38105861 PMCID: PMC10719203 DOI: 10.1007/s12663-023-01951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/29/2023] [Indexed: 12/19/2023] Open
Abstract
Background Rhino-oculo-cerebral Mucormycosis (ROCM) is a well-known complication post-COVID-19 infection. The extension of this disease into the oral cavity is a grey area with no proper protocol for management of the same in the existing literature. Based on our experience in the management of oral extension, this study aims to propose a protocol to treat these cases. Aim To derive a classification for the surgeon from retrospectively collected data of 53 operated cases of oral Mucormycosis. Settings and Design Hospital record-based cross-sectional study; evaluation of the previously treated 53 cases of oral extension of post-COVID-19 Rhino-oculo-cerebral Mucormycosis in the duration between May 2021 to August 2021. Follow-up for a period of 1 year. Methods and Material Based on the preoperative data, 4 parameters were taken -Tooth tenderness, Tooth mobility, Palatal perforation, and Radiological findings. A clinical-radiological classification system was derived based on the intraoperative data from the OT notes and the preoperative findings corresponding to the 4 parameters. Statistical Analysis The statistical analysis was done using SPSS for windows version 20 software (SPSS Inc., Chicago, IL, USA). Results Totally 220 cases of ROCM were recorded in our institute. Of this, 53 patients were treated for ROCM extending into the oral cavity. In 27 patients, we were able to achieve primary closure. In 26 patients, there was oro-antral communication after removal of the palate. Based on this data, we derived a protocol that may be used by the treating surgeon to manage oral cavity cases of ROCM, so that aggressive tissue resection may be avoided unnecessarily. Conclusion This protocol will help the treating surgeon to have a clearer outlook on treating this disease.
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Affiliation(s)
- Kranti Bhavana
- Department of ENT, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Aiswarya Vaidyanathan
- Department of Dentistry, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Naqoosh Haidry
- Department of Dentistry, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Bhartendu Bharti
- Department of ENT, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Anil Kumar
- Trauma and Emergency medicine, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Peeyush Shivhare
- Department of Dentistry, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
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27
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Sindi AS, Kumar L, Verma A, Pal US, Sayed ME, Mattoo K, Morsy MS, Baba SM, Khalid I, Baig FA, Basheer SA, Kota MZ, Shafi S. Prosthodontic Rehabilitation's Role in Alleviating Anxiety and Depression in Mucormycosis-Induced Maxillectomy Patients Post-COVID-19. Med Sci Monit 2023; 29:e941488. [PMID: 37997301 PMCID: PMC10683707 DOI: 10.12659/msm.941488] [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: 06/15/2023] [Accepted: 08/14/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the influence of maxillofacial prosthodontic rehabilitation on anxiety/depression severity in patients with rhino-orbital cerebral mucormycosis (ROCM) after maxillectomy. MATERIAL AND METHODS Sixty post-mucormycotic patients treated with maxillectomy (33 males, 27 females) were divided into 5 groups based on maxillectomy types (unilateral/bilateral, subtotal/total) and treatment given (psychotherapy/obturator/implant/orbital/ocular prosthesis). Anxiety and depression symptoms were assessed using appearance anxiety inventory (AAI) and patient health questionnaire (PHQ9). Data were collected at 4 time intervals [T0 (before prosthesis), T1 (2 weeks after prosthesis), T2 (6 months) and T3 (1 year). Frequency distribution and mean values were determined for individual group/subgroups/total cohort. Differences between groups were determined using one-way ANOVA (single-factor/Friedman's) followed by post hoc correction (Bonferroni) and t test for unequal variance with probability P value being statistically significant at <0.05. RESULTS The mean scores for appearance anxiety were 29.13±4.72 (diagnostic for existing body dysmorphic disorder) at T0, which decreased to 16.88±3.02 at T3 for the total cohort. The differences for the gender-based cohort, its various groups, and respective subgroups were significant (P<0.05) at various time intervals. The mean scores in the total cohort for depression symptom severity were 16.81±4.89 (moderately severe) at T0, which increased to 18.5±4.94 at T1, followed by reduction at T2 (12.0±4.43; moderate) and T3 (7.38±3.37; mild). Gender differences for both variables were found to be statistically significant (P<0.05). CONCLUSIONS Comprehensive rehabilitation that included a diagnosis of psychological symptoms followed by psychotherapeutic/pharmacotherapeutic/prosthodontic intervention reduced the anxiety/depression symptom levels to normal at 1 year.
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Affiliation(s)
- Abdulelah Sameer Sindi
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Lakshya Kumar
- Department of Prosthodontics, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Aditi Verma
- Department of Prosthodontics, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Uma Shanker Pal
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Mohammed E. Sayed
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Khurshid Mattoo
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Mohamed S.M. Morsy
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Suheel Manzoor Baba
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Imran Khalid
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Fawaz A.H. Baig
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Sulphi Abdul Basheer
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Mohammad Z. Kota
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Shabina Shafi
- Specialist Pediatric Dentist, Saudi Dental Group, Khamis Mushayt, Saudi Arabia
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Fatima N, Ahmed S, Shameem M, Ahmed A, Hasan W, Khan PA. Rhino-orbito-cerebral mucormycosis during Covid-19 pandemic- a prospective observational study. Indian J Med Microbiol 2023; 46:100467. [PMID: 37651764 DOI: 10.1016/j.ijmmb.2023.100467] [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: 03/23/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE An unprecedented rise in mucormycosis cases; apparently called 'an epidemic within a pandemic' was seen worldwide. Therefore, the following study was conducted to know the epidemiology, underlying risk factors, diagnostic approach, and possible outcome of mucormycosis during the Covid-19 pandemic. METHODS A prospective observational study was conducted on patients with a high index of clinical suspicion of mucormycosis Data about demographics, co-morbidities, laboratory investigations, radiology, management, and outcomes were collected. RESULTS We got 45 cases of proven Rhino-orbital-cerebral-mucormycosis (ROCM) from clinically suspected cases. Covid-19 was the most common underlying risk factor (n = 41, 91.11%) followed by Diabetes mellitus (DM) (n = 39; 86.67%). Steroids and oxygen usage were noted in 53.66% (n = 22) and 41.46% (n = 17) respectively. Among the 51 suspected cases of mucormycosis, 47 were supported by radiodiagnosis. Histopathology diagnosed the highest number of mucormycosis cases (n = 44; 97.78%), followed by KOH examination (n = 36; 80%) and Culture (n = 28; 62.22%). The most common species isolated from the tissue samples was Rhizopus species (n = 17; 60.71%), followed by Mucor species (n = 7; 25%). The mortality rate was 17.14%. CONCLUSION DM, Covid-19, and corticosteroids are the chief underlying risk factor for ROCM. Rhizopus spp. was the most dominant etiological agent. Early diagnosis and management with combined medical & surgical intervention have a better survival rate.
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Affiliation(s)
- Nazish Fatima
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Shariq Ahmed
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India.
| | - Mohammad Shameem
- Department of TB and Respiratory Disease, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Aftab Ahmed
- Department of Oto-Rhino-Laryngology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Wasil Hasan
- Department of Biochemistry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Parvez A Khan
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
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Lin TPH, Sen M, Gupta V, Agrawal R, Lanzetta P, Giannaccare G, Chan CKM, Agrawal K, Menia NK, Rojas-Carabali W, Arora A, Martinuzzi D, Taloni A, Rubinato L, Coco G, Sarao V, Veritti D, Chen L, Honavar SG, Lam DSC. Update on coronavirus disease 2019: Ophthalmic Manifestations and Adverse Reactions to Vaccination. Asia Pac J Ophthalmol (Phila) 2023; 12:512-536. [PMID: 38117598 DOI: 10.1097/apo.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 12/22/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 was one of the most devastating public health issues in recent decades. The ophthalmology community is as concerned about the COVID-19 pandemic as the global public health community is, as COVID-19 was recognized to affect multiple organs in the human body, including the eyes, early in the course of the outbreak. Ophthalmic manifestations of COVID-19 are highly variable and could range from mild ocular surface abnormalities to potentially sight and life-threatening orbital and neuro-ophthalmic diseases. Furthermore, ophthalmic manifestations may also be the presenting or the only findings in COVID-19 infections. Meanwhile, global vaccination campaigns to attain herd immunity in different populations are the major strategy to mitigate the pandemic. As novel vaccinations against COVID-19 emerged, so were reports on adverse ophthalmic reactions potentially related to such. As the world enters a post-pandemic state where COVID-19 continues to exist and evolve as an endemic globally, the ophthalmology community ought to be aware of and keep abreast of the latest knowledge of ophthalmic associations with COVID-19 and its vaccinations. This review is a summary of the latest literature on the ophthalmic manifestations of COVID-19 and the adverse ophthalmic reactions related to its vaccinations.
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Affiliation(s)
- Timothy P H Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Mrittika Sen
- Ocular Oncology and Ophthalmic Plastic Surgery Services, Raghunath Netralaya, Mumbai, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Duke NUS Medical School, National University of Singapore, Singapore
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Giuseppe Giannaccare
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Kajal Agrawal
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
| | - Nitin Kumar Menia
- All India Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
| | - William Rojas-Carabali
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Andrea Taloni
- University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Leopoldo Rubinato
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Giulia Coco
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Lizhen Chen
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
| | - Santosh G Honavar
- Ocular Oncology and Ophthalmic Plastic Surgery Services, Centre for Sight Eye Hospital, Hyderabad, India
| | - Dennis S C Lam
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- The C-MER Dennis Lam and Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
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Singh A, Goel G, Khan M, Kanodia A, Sikka K, Thakar A. Factors affecting clinical outcome in COVID-associated rhino-orbito-cerebral mucormycosis (CAROM) patients-An ambispective, single-arm, observational study. Am J Otolaryngol 2023; 44:103975. [PMID: 37478538 DOI: 10.1016/j.amjoto.2023.103975] [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: 05/23/2023] [Accepted: 07/04/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND COVID-associated Rhino-Orbito-Cerebral Mucormycosis (CAROM) appeared as an epidemic in India during the second wave of the COVID-19 pandemic during the months of March to May 2021. Though many reports have highlighted cross sectional and short-term attributes related to CAROM, long term follow up data is sparse. OBJECTIVE This report aims to analyze the follow-up outcomes in consecutive patients presenting to us during the epidemic. PATIENTS AND METHODS This was an ambispective observational analytical study, recruiting the consecutive patients admitted to our tertiary care centre during the period of the CAROM epidemic. The mortality rate during the follow-up and various factors affecting survival were studied using univariable and multivariable statistics with the Stata 14.0 software. RESULTS Of the 189 patients studied, eight were lost to follow-up. The outcome analysis was performed for the 181 patients. 93.6 % (162/173) of the patients had diabetes. The All-cause mortality was 45 % (81/181), while the ROCM-specific mortality was found to be 24 % (46/181) at a median follow-up of 176 days (IQR: 21-217 days). With univariable analysis, increasing age, higher serum IL-6 levels, presence of additional comorbidities (in addition to Diabetes and hypertension), bilateral disease, skin necrosis, palatal involvement, infratemporal fossa involvement, and impaired vision/ocular movements were found to be associated with increased mortality. However, on multivariable analysis, only 1) increasing age, 2) raised serum IL-6 levels, and 3) bilateral disease were predictive of increased mortality. Surgical debridement (endoscopic, palatal removal, orbital exenteration, neurosurgical intervention) was associated with significantly reduced mortality on both univariable and multivariable analysis. CONCLUSION Our intermediate-term follow-up data showed advanced age at presentation, raised IL-6 levels, and bilateral sinonasal involvement to be predictive of increased mortality, while surgical debridement is significantly protective from mortality in CAROM patients.
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Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Goel
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Kanodia
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Alok Thakar
- Department of Otorhinolaryngology and Head- Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Jin Y, Liu H, Zhao B, Pan W. ChatGPT and mycosis- a new weapon in the knowledge battlefield. BMC Infect Dis 2023; 23:731. [PMID: 37891532 PMCID: PMC10605453 DOI: 10.1186/s12879-023-08724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
As current trend for physician tools, ChatGPT can sift through massive amounts of information and solve problems through easy-to-understand conversations, ultimately improving efficiency. Mycosis is currently facing great challenges, including high fungal burdens, high mortality, limited choice of antifungal drugs and increasing drug resistance. To address these challenges, We asked ChatGPT for fungal infection scenario-based questions and assessed its appropriateness, consistency, and potential pitfalls. We concluded ChatGPT can provide compelling responses to most prompts, including diagnosis, recommendations for examination, treatment and rational drug use. Moreover, we summarized exciting future applications in mycosis, such as clinical work, scientific research, education and healthcare. However, the largest barriers to implementation are deficits in indiviudal advice, timely literature updates, consistency, accuracy and data safety. To fully embrace the opportunity, we need to address these barriers and manage the risks. We expect that ChatGPT will become a new weapon in in the battlefield of mycosis.
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Affiliation(s)
- Yi Jin
- Department of Dermatology, Shanghai Key Laboratory of Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, P.R. China
| | - Hua Liu
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Zhao
- Department of Anesthesiology and SICU, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P.R. China.
| | - Weihua Pan
- Department of Dermatology, Shanghai Key Laboratory of Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, P.R. China.
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Sedaghat N, Etemadifar M, Ghasemi P, Naghizadeh M, Mokari Y, Salari M, Golastani B. Neuro-mucormycosis: Lessons from COVID-19-associated cases. CURRENT JOURNAL OF NEUROLOGY 2023; 22:255-260. [PMID: 38425352 PMCID: PMC10899533 DOI: 10.18502/cjn.v22i4.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/13/2023] [Indexed: 03/02/2024]
Abstract
Background: Scarce data are available on the neurological presentations of coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) and COVID-19-unrelated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to compare the neurological presentations and their associated outcomes in patients with CAM and COVID-19-unrelated ROCM. Methods: In December 2021, a case-control analysis was conducted on the CAM (case group) and COVID-19-unrelated ROCM (control group) referrals of one center in Isfahan, Iran. Confirmed CAM patients from January 2020 to December 2021 constituted the case group, and patients with COVID-19-unrelated ROCM from 2016-2019 constituted the control group. Their data were then analyzed using proper (non) parametric tests and generalized linear models (GLM), therein P-value below 0.05 was considered as the criterion of statistical significance, and the SPSS software was used. Results: After retrieving data on 177 patients with mucormycosis, 78 patients with CAM were included as the case group and 72 patients with COVID-19-unrelated ROCM were included as the control group. Neurological presentations suggestive of second, third, and eighth cranial nerve involvement were more prevalent in the CAM group (all with P < 0.05). The mortality rate in the CAM group was 1.9 times that of the controls (P = 0.01), being explained by higher extent of corticosteroid administration among them. Higher age and presentation with gait ataxia, ptosis, and mydriasis were considered to be predictive of poor prognosis in patients with CAM (all with P < 0.05). Conclusion: The neurological manifestations of CAM differ from COVID-19-unrelated ROCM based on the presented results, some of which are associated with poor prognosis. Further replication is warranted to confirm our retrospective analyses.
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Affiliation(s)
- Nahad Sedaghat
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Etemadifar
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pouria Ghasemi
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Naghizadeh
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokari
- School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Golastani
- Department of Cell and Molecular Biology and Microbiology, School of Biological Science and Technology, University of Isfahan, Isfahan, Iran
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Kumar S, Anita, Dev A, Kumar A, Kumar Nayan S, Singh S. The Study of Clinical Profile of Patients With Mucormycosis During COVID-19 Pandemic in Tertiary Care Hospital. Cureus 2023; 15:e47065. [PMID: 38021649 PMCID: PMC10651161 DOI: 10.7759/cureus.47065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Mucormycosis has gained a huge number of cases in the second wave of post COVID-19 infection, which may be attributed to increased awareness, advancement in diagnostic techniques, and an increase in the prevalence of predisposing factors. This study evaluated the pattern, risk factors, and clinical profile of patients with mucormycosis during the second wave of the COVID-19 pandemic. METHODS A prospective observational study was conducted in the Department of Emergency Medicine of a dedicated tertiary care hospital for COVID-19. The Institutional Ethics Committee approved the study. One hundred five patients diagnosed with mucormycosis were included from June 2021 to December 2021. Informed consent was obtained from the patients. Data on demography, clinical features, predisposing factors, co-morbid conditions, and microbiological samples were obtained and analyzed. RESULTS Out of 105 patients, 71 were male, and 34 were female. The patient presented with mucormycosis between the 2nd and 3rd week of post COVID-19 infection. Incidence was mainly seen in patients in their fifties, mostly associated with diabetes mellitus (DM) (53.30%), oxygen administration (80%), and previous use of steroids (45.71%). Predominantly, males were more affected. The most common presentation was headache (50.47%), orbital pain with restricted ocular movement (47.67%), proptosis (42.85%), and diminished vision (41.90%). Rhino-orbital-cerebral mucormycosis (ROCM) was the most common presentation of mucormycosis, while only five cases of pulmonary mucormycosis were found. CONCLUSION ROCM was the most common presentation of mucormycosis between the second and third week of post COVID-19 infection. Diabetes mellitus and inadvertent use of steroids were major predisposing factors. Therefore, a high degree of suspicion and early diagnosis with initiation of treatment is warranted in cases of mucormycosis in post COVID-19 infection.
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Affiliation(s)
- Santosh Kumar
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Anita
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Anand Dev
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Abhay Kumar
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | | | - Siddharth Singh
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Raina D, Rohilla R, Patwal S, Pandita A. The Second COVID-19 Wave Is a Tsunami With Aftershocks: Mucormycosis Ire as Seen in a Tertiary Care Hospital in Uttarakhand, India. Cureus 2023; 15:e47358. [PMID: 38021725 PMCID: PMC10657149 DOI: 10.7759/cureus.47358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND During the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) or the coronavirus disease 2019 (COVID-19) pandemic in recent times, an upsurge of invasive fungal infections (IFIs) such as mucormycosis was witnessed by many countries like India. This COVID-19-associated mucormycosis (CAM) has presented as a menace to the already creaking health infrastructure. Clinical manifestations, risk factors, and end clinical outcomes varied for every other region/country. The aim of this study is to delineate and analyze plausible clinical and epidemiological factors and associated predictors of CAM in suspected patients presenting to a tertiary care hospital in Uttarakhand, India, during the second wave of COVID-19 in India. MATERIAL AND METHODS A total of 200 cases of suspected post‑COVID-19 mucormycosis were enrolled. Data were collected taking into account parameters such as hospitalization and ICU admissions during the episode of COVID-19 infection, steroid/antibiotics/oxygen requirement, and comorbidities such as diabetes mellitus, hypertension, or any chronic illness and outcome. RESULTS Participants diagnosed with CAM using KOH examination and fungal culture were analyzed in the study (n=46). The median age of patients included was 48, 73.9% were males, and 26% were females. The major predisposing factor was found to be diabetes mellitus type 2. Our work suggests that the mean duration between COVID-19 episodes and CAM was 11.86 days with a significant statistical association. Oxygen requirement and imprudent use of steroids/antibiotics were also allied with mucormycosis. CONCLUSION The burden of such IFIs is expected to be unveiled in tropical countries during pandemics such as COVID-19, which lead to immunosuppression in masses post-treatment. Comorbidities such as diabetes, chronic kidney disease, and hypertension add to the risk of acquiring other infectious disease. Such times require competent healthcare professionals such as diagnosticians, physicians, and surgeons who are skilled to manage such IFIs timely.
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Affiliation(s)
- Dimple Raina
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Ranjana Rohilla
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Shiwang Patwal
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Ajay Pandita
- Community Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
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S A, Govindarajan K, S Y, Parivallal PLG, Hariharan S, Khaleel A, Sb PT, Goswami K, Saravanan P, Panneerselvam D. A Comparative Study on Survivors Versus Non-Survivors Among Diabetic Patients Having Mucormycosis. Cureus 2023; 15:e47932. [PMID: 38034231 PMCID: PMC10684971 DOI: 10.7759/cureus.47932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Mucormycosis is a rare opportunistic fungal infection caused by fungi belonging to the Mucorales order and Mucoraceae family. It ranks as the third most prevalent angioinvasive fungal infection, following aspergillosis and candidiasis. This severe infection typically affects individuals with compromised immune systems, including those with hematological malignancies like leukemia and lymphoma, individuals who have undergone stem cell transplants, and people with diabetes mellitus. Individuals in good health are rarely affected, making immunocompromised individuals particularly vulnerable to this potentially fatal fungal disease. The aim of this study was to perform a comparative analysis of survivors versus non-survivors among diabetes patients admitted with mucormycosis. Methodology This was a descriptive observational study. A total of 338 patients were enrolled in the study. The study variables included demographics, COVID-19 infection, diabetes mellitus history, steroid use, use of oxygen support, and steam inhalation. Results Of the total 338 patients enrolled in the study, 253 (74.9%) were male and 85 (25.01%) were female. The number of survivors were 305 (90.2%) and non-survivors were 33(9.8%). The mean age of survivors was 52.50 ± 11.31 and non-survivors was 54.06 ± 8.54 years. Patients who underwent steam inhalation had a higher chance of survival compared to those who did not undergo steam inhalation and this association was statistically significant (p=0.01). Males showed a higher chance of survival (93.7%) as compared to females (80.0%). The associations between oxygen support, steroid use, and COVID-19 infection with the survival status were statistically non-significant. Conclusion There was a strong association between the history of steam inhalation and the outcome of mucormycosis among diabetes patients admitted with mucormycosis. Female patients demonstrated a higher fatality rate than males indicating a significant gender disparity observed in cases. Our findings may help to better identify and treat patients who are at higher risk for severe forms of mucormycosis.
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Affiliation(s)
- Anbumathi S
- Medicine, Madras Medical College, Chennai, IND
| | | | - Yogesh S
- Medicine, Madras Medical College, Chennai, IND
| | | | | | | | | | | | - Pushpa Saravanan
- Diabetes and Endocrinology, Madras Medical College, Chennai, IND
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Abd El-Baky RM, Shady ER, Yahia R, Ahmed FY, Ramadan M, Ahmed HR, Al-Kadmy IMS, Ramadan YN, Hetta HF. COVID-19 associated Mucormycosis among ICU patients: risk factors, control, and challenges. AMB Express 2023; 13:99. [PMID: 37736777 PMCID: PMC10516834 DOI: 10.1186/s13568-023-01599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic is still difficult to be controlled. The spread of this virus and the emergence of new variants are considered a great challenge worldwide. Disturbance in infection control guidelines implementation, use of steroids, antibiotics, hospital crowdedness, and repeated use of oxygen masks during the management of critically ill COVID-19 patients lead to an increase in the rate of opportunistic infections. So, patients need to fight both the virus with its different variants and opportunistic pathogens including bacteria and fungi especially patients with diabetes mellitus, malignancy, or those who undergo hemodialysis and receive deferoxamine. During the pandemic, many cases of Mucormycosis associated with COVID-19 infection were observed in many countries. In this review, we discuss risk factors that increase the chance of infection by opportunistic pathogens, especially fungal pathogens, recent challenges, and control measures.
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Affiliation(s)
- Rehab Mahmoud Abd El-Baky
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt.
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, 11566, Egypt.
| | - Esraa R Shady
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, 11566, Egypt
| | - Ramadan Yahia
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, 11566, Egypt
| | - Fatma Y Ahmed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt
| | - Mohamed Ramadan
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt
| | - Hala Rady Ahmed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt
| | - Israa M S Al-Kadmy
- Branch of Biotechnology, Department of Biology, College of Science, Mustansiriyah University, POX 10244, Baghdad, Iraq
| | - Yasmin N Ramadan
- Department of Microbiology and Immunology, Faculty of Pharmacy, Assiut University, Assiut, 71515, Egypt.
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
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Prabhakar A, Bansal S, Vyas S, Bhatia V, Kumar A, Patro S, Singh U, Panda N, Singh P, Bhalla A, Puri GD, Ahuja CK. Clinicoradiological Profile of COVID-19-Associated Rhino-Orbital Cerebral Mucormycosis with a Focus on Computed Tomography: A Clinical Case Series and Review. Am J Trop Med Hyg 2023; 109:600-607. [PMID: 37487562 PMCID: PMC10484265 DOI: 10.4269/ajtmh.22-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/09/2023] [Indexed: 07/26/2023] Open
Abstract
COVID-19-associated rhino-orbital cerebral mucormycosis (ROCM) has a rapidly evolving course with high morbidity and mortality. We describe imaging features of COVID-19-associated ROCM based on noncontrast computed tomography (NCCT). This retrospective single-center observational study included 50 patients with COVID-19 from January 1, 2021 to June 30, 2021 who subsequently developed ROCM confirmed by fungal culture studies. All patients underwent NCCT of the paranasal sinuses as the diagnostic workup. The involvement of the nasal cavity, paranasal sinuses, orbits, and intracranial cavity was identified and graded. The ethmoid sinuses were most commonly involved [right (n = 46 of 50) > left (n = 45 of 50)], followed by the maxillary, sphenoid, and frontal sinuses. Thinning and erosions of the hard palate were noted in 18% of patients (n = 9), whereas 34% (n = 17) showed dehiscence of the lamina papyracea. Retromaxillary fat stranding was noted in 68% of patients (n = 34). Severe ethmoid sinusitis was associated significantly with ipsilateral pterygopalatine fossa involvement. The extraocular muscles were involved in 64% of patients (n = 32), with 84% (n = 42) showing orbital fat stranding. Proptosis of the affected eye was seen in 66% of patients, optic nerve involvement in 52%, and irregularity of globe contour in 12% (n = 6). The cavernous sinuses were affected in 10% of patients (n = 5), with three of them having temporal infarcts. COVID-19-associated ROCM is an acute, invasive fungal disease characterized by multisinus involvement, often with orbital and intracranial extension. Bilateral involvement with rapid progression should alert one to underlying COVID-19 disease.
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Affiliation(s)
- Anuj Prabhakar
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Bansal
- Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Bhatia
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Kumar
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabha Patro
- Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Panda
- Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjeet Singh
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Kamal Ahuja
- Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Tran E, Phu V, Xu R, Teoderascu A, Aly M, Shah N, Malvankar-Mehta MS. Ocular manifestations of COVID-19: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00248-X. [PMID: 37683691 DOI: 10.1016/j.jcjo.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/30/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Our study aims to build on our understanding of COVID-19 by detailing a comprehensive look at the prevalence of different ocular manifestations related to COVID-19 infection. DESIGN Systematic review and meta-analysis. METHODS Eligible studies published between June 20, 2021, and May 11, 2023, were retrieved from the MEDLINE, EMBASE, and CINAHL databases as well as grey literature. Covidence was used to conduct the systematic review. Duplicate records were removed, and 2 independent reviewers screened records for relevance. After screening, a risk-of-bias assessment was carried out. Data were extracted, and a meta-analysis was performed using STATA 14.0. Fixed-effects and random-effects models were computed based on heterogeneity. RESULTS Our meta-analysis included 43 articles with a total of 10,572 subjects. The results showed that COVID-19 patients had a significantly higher prevalence of conjunctivitis (effect size [ES] = 0.11; 95% CI, 0.07-0.15), ptosis (ES = 0.22; 95% CI, 0.15-0.30), and ophthalmoplegia (ES = 0.40; 95% CI, 0.06-0.74). Our results also indicate that COVID-19 patients have higher prevalence of cotton wool spots (ES = 0.06; 95% CI, 0.03-0.09), retinal hemorrhages (ES = 0.12; 95% CI, 0.06-0.18), and retinal vein tortuosity (ES = 0.19; 95% CI, 0.09-0.35). CONCLUSION COVID-19 can exhibit extrapulmonary manifestations, affecting both the anterior and posterior segments of the eye. Common anterior-segment findings include conjunctivitis, whereas posterior-segment findings may include cotton wool spots, retinal hemorrhages, and retinal vein tortuosity. Improving our understanding of the ocular manifestations of COVID-19 has the potential to facilitate quicker diagnosis and subsequent treatment.
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Affiliation(s)
- Edward Tran
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Vivian Phu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Riley Xu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Angela Teoderascu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Mohamed Aly
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Nirmit Shah
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
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Roland LT, Humphreys IM, Le CH, Babik JM, Bailey CE, Ediriwickrema LS, Fung M, Lieberman JA, Magliocca KR, Nam HH, Teo NW, Thomas PC, Winegar BA, Birkenbeuel JL, David AP, Goshtasbi K, Johnson PG, Martin EC, Nguyen TV, Patel NN, Qureshi HA, Tay K, Vasudev M, Abuzeid WM, Hwang PH, Jafari A, Russell MS, Turner JH, Wise SK, Kuan EC. Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence-Based Review with Recommendations. Int Forum Allergy Rhinol 2023; 13:1615-1714. [PMID: 36680469 DOI: 10.1002/alr.23132] [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: 08/23/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acute invasive fungal sinusitis (AIFS) is an aggressive disease that requires prompt diagnosis and multidisciplinary treatment given its rapid progression. However, there is currently no consensus on diagnosis, prognosis, and management strategies for AIFS, with multiple modalities routinely employed. The purpose of this multi-institutional and multidisciplinary evidence-based review with recommendations (EBRR) is to thoroughly review the literature on AIFS, summarize the existing evidence, and provide recommendations on the management of AIFS. METHODS The PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through January 2022. Studies evaluating management for orbital, non-sinonasal head and neck, and intracranial manifestations of AIFS were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on management principles for AIFS were generated. RESULTS A review and evaluation of published literature was performed on 12 topics surrounding AIFS (signs and symptoms, laboratory and microbiology diagnostics, endoscopy, imaging, pathology, surgery, medical therapy, management of extrasinus extension, reversing immunosuppression, and outcomes and survival). The aggregate quality of evidence was varied across reviewed domains. CONCLUSION Based on the currently available evidence, judicious utilization of a combination of history and physical examination, laboratory and histopathologic techniques, and endoscopy provide the cornerstone for accurate diagnosis of AIFS. In addition, AIFS is optimally managed by a multidisciplinary team via a combination of surgery (including resection whenever possible), antifungal therapy, and correcting sources of immunosuppression. Higher quality (i.e., prospective) studies are needed to better define the roles of each modality and determine diagnosis and treatment algorithms.
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Affiliation(s)
- Lauren T Roland
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Christopher H Le
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Jennifer M Babik
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Christopher E Bailey
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Lilangi S Ediriwickrema
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, Irvine, California, USA
| | - Monica Fung
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joshua A Lieberman
- Department of Pathology and Laboratory Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University Medical Center, Atlanta, Georgia, USA
| | - Hannah H Nam
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, Orange, California, USA
| | - Neville W Teo
- Department of Otorhinolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Penelope C Thomas
- Department of Radiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Blair A Winegar
- Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Abel P David
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Patricia G Johnson
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Elaine C Martin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Theodore V Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Neil N Patel
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Hannan A Qureshi
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Kaijun Tay
- Department of Otorhinolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Milind Vasudev
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Matthew S Russell
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University Medical Center, Atlanta, Georgia, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
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Cumpa-Quiroz R, Elguera-Falcón F, Guevara-Lazo DR. Emergence of Rhino-Orbito-Cerebral Mucormycosis in Peru: Impact of the COVID-19 Pandemic. Cureus 2023; 15:e45240. [PMID: 37842460 PMCID: PMC10576593 DOI: 10.7759/cureus.45240] [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: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Mucormycosis is an invasive fungal infection caused by Mucorales that has been increasingly recognized over the years, particularly during the COVID-19 pandemic. Nevertheless, in Peru, there has been limited research on this disease. This study seeks to provide insights into the demographics, clinical presentations, treatment, and outcomes of patients with mucormycosis, before and during the COVID-19 pandemic. Materials and methods We conducted a retrospective case series by reviewing the medical records of Peruvian patients hospitalized at a referral medical center between 2017 and 2021. The selection criteria included patients aged 18 years or older with clinical features of rhino-orbito-cerebral mucormycosis supported by radiological imaging. We extracted data related to risk factors for mucormycosis infection, clinical presentation, management, and hospitalization. Data analysis was performed using Stata software (StataCorp LLC, College Station, Texas, USA) to compare patient groups before and during the COVID-19 pandemic. Results Nineteen cases met our selection criteria: 11 men and eight women with an average age of 57.6 ± 10.6 years. All 19 patients had type 2 diabetes mellitus as comorbidity, with 13 cases exhibiting uncontrolled diabetes. Six patients presented before the COVID-19 pandemic, while 13 during its course. Within the group of patients diagnosed during the pandemic, nine were diagnosed with SARS-CoV-2 infection. Regarding the site of mucormycosis infection, the paranasal sinuses were predominantly involved. Survival analysis indicated that patients who developed mucormycosis during the COVID-19 pandemic, those with uncontrolled diabetes, or those who did not undergo surgery had lower probabilities of survival. Conclusion Mucormycosis is a rare infection associated with high mortality and morbidity with increased frequency during the COVID-19 pandemic. Early diagnosis, timely administration of antifungal treatment, surgery, and effective management of comorbidities can have life-saving implications. Unfortunately, despite the availability of various diagnostic tests and less toxic antifungal options such as liposomal amphotericin-B, such resources are not accessible in Peru's national hospitals.
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Affiliation(s)
- Robert Cumpa-Quiroz
- Department of Internal Medicine, Hospital Nacional Arzobispo Loayza, Lima, PER
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Sharma B, Nonzom S. Mucormycosis and Its Upsurge During COVID-19 Epidemic: An Updated Review. Curr Microbiol 2023; 80:322. [PMID: 37592083 DOI: 10.1007/s00284-023-03430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
Although mucormycosis may have reached an epidemic situation during the COVID-19 pandemic, the term was much more familiar even before the COVID-19 period. The year 2020 showed an outbreak of novel coronavirus (SARS-CoV-2) which affected millions of people all over the world. One of the noticeable complications observed to be associated with this disease is mucormycosis. It is an opportunistic infection caused by members of the Order Mucorales existing worldwide and has been commonly reported as a laboratory contaminant for a long time. However, nowadays due to the changes in the host environment, they have been emerging as potent opportunistic pathogens responsible for causing primary infections or coinfections with other diseases eventually resulting in morbidity and even mortality in severe cases. Although immunocompromised patients are more susceptible to this infection, few cases have been reported in immunocompetent individuals. Various risk factors which are responsible for the acquisition of mucormycosis include diabetes mellitus type 2, ketoacidosis, hematological malignancies, organ transplants, and chemotherapy recipients. Among the various etiological agents, Rhizopus is found to be the most common, and rhino-cerebral to be the most frequent clinical presentation. As far as pathogenesis is concerned, host cell invasion, thrombosis, and necrosis are the main events in the progression of this disease. The aim of the present review is to address a complete spectrum of mucormycosis and COVID-19-associated mucormycosis (CAM) in a single article. Both global and Indian scenarios of mucormycosis are taken into account while framing this review.
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Affiliation(s)
- Bharti Sharma
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India
| | - Skarma Nonzom
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India.
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Senapathy G, Putta T, Sistla SK. Magnetic resonance imaging in COVID-19-associated acute invasive fungal rhinosinusitis - Diagnosis and beyond. J Clin Imaging Sci 2023; 13:23. [PMID: 37680251 PMCID: PMC10481822 DOI: 10.25259/jcis_46_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/21/2023] [Indexed: 09/09/2023] Open
Abstract
Objectives The aim of the study was to evaluate the magnetic resonance imaging (MRI) features of acute invasive fungal rhinosinusitis (AIFRS) at presentation and on follow-up imaging when patients receive treatment with systemic antifungal therapy and surgical debridement. Material and Methods This is a retrospective analysis of imaging data from a cohort of patients diagnosed with AIFRS during the second wave of COVID-19 in single tertiary referral hospital in South India between March 2021 and May 2021 (n = 68). Final diagnosis was made using a composite reference standard which included a combination of MRI findings, clinical presentation, nasal endoscopy and intraoperative findings, and laboratory proof of invasive fungal infection. Analysis included 62 patients with "Definite AIFRS" findings on MRI and another six patients with "Possible AIFRS" findings on MRI and laboratory proof of invasive fungal infection. Follow-up imaging was available in 41 patients. Results The most frequent MRI finding was T2 hypointensity in the sinonasal mucosa (94%) followed by mucosal necrosis/loss of contrast-enhancement (92.6%). Extrasinosal inflammation with or without necrosis in the pre-antral fat, retroantral fat, pterygopalatine fossa, and masticator space was seen in 91.1% of the cases. Extrasinosal spread was identified on MRI even when the computed tomography (CT) showed intact bone with normal extrasinosal density. Orbital involvement (72%) was in the form of contiguous spread from either the ethmoid or maxillary sinuses; the most frequent presentation being orbital cellulitis and necrosis, with some cases showing extension to the orbital apex (41%) and inflammation of the optic nerve (32%). A total of 22 patients showed involvement of the cavernous sinuses out of which 10 had sinus thrombosis and five patients had cavernous internal carotid artery involvement. Intracranial extension was seen both in the form of contiguous spread to the pachymeninges over the frontal and temporal lobes (25%) and intra-axial involvement in the form of cerebritis, abscesses, and infarcts (8.8%). Areas of blooming on SWI were noted within the areas of cerebritis and infarcts. Perineural spread of inflammation was seen along the mandibular nerves across foramen ovale in five patients and from the cisternal segment of trigeminal nerve to the root exit zone in pons in three patients. During follow-up, patients with disease progression showed involvement of the bones of skull base, osteomyelitis of the palate, alveolar process of maxilla, and zygoma. Persistent hyperenhancement in the post-operative bed after surgical debridement and resection was noted even in patients with stable disease. Conclusion Contrast-enhanced MRI must be performed in all patients with suspected AIFRS as non-contrast MRI fails to demonstrate tissue necrosis and CT fails to demonstrate extrasinosal disease across intact bony walls. Orbital apex, pterygopalatine fossa, and the cavernous sinuses form important pathways for disease spread to the skull base and intracranial compartment. While cerebritis, intracranial abscesses, and infarcts can be seen early in the disease due to the angioinvasive nature, perineural spread and skull base infiltration are seen 3-4 weeks after disease onset. Exaggerated soft-tissue enhancement in the post-operative bed after debridement can be a normal finding and must not be interpreted as disease progression.
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Affiliation(s)
- Gayatri Senapathy
- Department of Radiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, Telangana, India
| | - Tharani Putta
- Department of Radiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, Telangana, India
| | - Srinivas Kishore Sistla
- Department of ENT, Asian Institute of Gastroenterology Hospitals, Hyderabad, Telangana, India
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Allaw F, Zakhour J, Nahhal SB, Koussa K, Bitar ER, Ghanem A, Elbejjani M, Kanj SS. Mucormycosis: A 14-Year Retrospective Study from a Tertiary Care Center in Lebanon. J Fungi (Basel) 2023; 9:824. [PMID: 37623595 PMCID: PMC10456049 DOI: 10.3390/jof9080824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Mucormycosis (MCM) is a serious invasive fungal disease (IFD) that is associated with high mortality, particularly in immunocompromised patients. A global surge in MCM cases was reported with the COVID-19 pandemic. We analyzed all recorded cases of MCM at the American University of Beirut Medical Center (AUBMC), a tertiary care center in Lebanon, over 14 years. We aimed to identify the incidence, seasonal variation, clinical characteristics of the patients, and predictors of mortality. We conducted a retrospective chart review between 1 January 2008 and 1 January 2023. All patients with proven or probable MCM were included in the study. Proven or probable MCM was defined by positive histopathology and/or positive cultures. A total of 43 patients were identified as having MCM. Their median age was 53 years, and the majority were males (58.1%). Most of the cases were diagnosed in the autumn season. In total, 67.4% of the patients had hematological malignancies (HMs), and 34.9% had uncontrolled diabetes mellitus (DM). The most common site of involvement was rhino-orbital-cerebral MCM (ROCM) (74%). The annual cases of MCM per 100,000 patient days increased markedly during the years of the COVID-19 pandemic (from 0 to 4.4 cases/100,000 patient days to 7.5 cases/100,000 during 2020 and 2021). Liposomal amphotericin (Ampho) B was used as a first-line agent in most of the patients (86%). The median duration of total in-hospital antifungal therapy was 21 days and 51.2% of the patients received step-down therapy with azoles. Surgical debridement and isolated ROCM were significantly associated with survival (p-value: 0.02 and <0.001, respectively). All-cause mortality was 46.7%, with chronic renal disease being significantly associated with mortality (p-value < 0.05). The incidence of MCM has been increasing at our institution, particularly since the COVID-19 pandemic. Early diagnosis, treatment, and surgical debridement improve patient outcomes and overall survival.
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Affiliation(s)
- Fatima Allaw
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 110236, Lebanon; (F.A.); (J.Z.); (S.B.N.)
| | - Johnny Zakhour
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 110236, Lebanon; (F.A.); (J.Z.); (S.B.N.)
| | - Sarah B. Nahhal
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 110236, Lebanon; (F.A.); (J.Z.); (S.B.N.)
| | - Karim Koussa
- Faculty of Medicine, American University of Beirut, Beirut 110236, Lebanon; (K.K.); (E.R.B.)
| | - Elio R. Bitar
- Faculty of Medicine, American University of Beirut, Beirut 110236, Lebanon; (K.K.); (E.R.B.)
| | - Anthony Ghanem
- Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, Beirut 110236, Lebanon;
| | - Martine Elbejjani
- Clinical Research Institute, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut 110236, Lebanon;
| | - Souha S. Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 110236, Lebanon; (F.A.); (J.Z.); (S.B.N.)
- Center for Infectious Diseases Research, American University of Beirut, Beirut 110236, Lebanon
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Kumar L, Verma A, Pal US, Mattoo K, Algarni YA, Bin Hassan SA, Baba SM, Jeri SY, Khateeb SU. Influence of Prosthodontic Rehabilitation Using Zygomatic Implants in Covid 19 Related Mucormycosis (Rhino-Orbital-Cerebral) Maxillectomy Patients Upon Post-Operative Stress, Anxiety and Functional Impairment: A Prospective Cohort Study. Clin Interv Aging 2023; 18:1201-1219. [PMID: 37547381 PMCID: PMC10404046 DOI: 10.2147/cia.s412625] [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: 03/16/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose To determine the influence of prosthodontic rehabilitation using zygomatic implants in partial maxillectomy upon post-operative stress, anxiety and functional impairment, due to covid 19 associated rhino-orbital-cerebral mucormycosis (ROCM). Patients and Methods Twenty maxillectomy patients fulfilling study criterion, received zygomatic implants (ZI) (quad zygoma) (ZDI Simpladent, Switzerland) retained/supported complete maxillary denture. Assessment of stress, anxiety, masticatory performance and speech were determined using diurnal salivary cortisol level, Appearance Anxiety Inventory, multiple sieve technique and auditory perception analysis, respectively. Data were recorded at 6 different stages of rehabilitation (after maxillectomy, implant placement, and after prosthesis delivery (1 week, 1 month, 6 months and 1 year)). Demographic data were expressed as frequency distribution, while mean values were used to find differences between various rehabilitation stages using Friedman and chi-square test with statistical significance value at p < 0.05. Results Average daily salivary cortisol levels declined from post maxillectomy (22.80 ± 0.902) to 1 year after prosthesis wearing (8.65 ± 0.985), indicating stress reduction after ZI rehabilitation. Mean scores for appearance anxiety reduced from pre-prosthetic rehabilitation (27.350 ± 3.030) to 1 year (8.950 ± 0.887) following prosthesis wearing. Functional parameters for mastication and speech also improved significantly during the course of rehabilitation. All differences between pre-prosthetic to 1-year stage after prosthesis wearing were found to be statistically significant at p < 0.05. Conclusion Post ROCM maxillectomy cases after prosthetic rehabilitation using zygomatic implants showed significant improvement in the psychological (stress and anxiety) as well as function (mastication and speech) characteristics. Rehabilitation post ROCM maxillectomy with the present approach of fixed prosthesis using zygomatic implants mitigates deficient mastication and speech. It also impacts positively on patient psychology by decreasing stress and anxiety.
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Affiliation(s)
- Lakshya Kumar
- Department of Prosthodontics, King George`s Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Aditi Verma
- Department of Prosthodontics, King George`s Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Uma Shanker Pal
- Department of Oral and Maxillofacial Surgery, King George`s Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Khurshid Mattoo
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, 45142, Kingdom of Saudi Arabia
| | - Youssef Abdullah Algarni
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Saeed Awod Bin Hassan
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Suheel Manzoor Baba
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Sumaya Yousuf Jeri
- Department of Orthodontics and Dentofacial Orthopedics, I.T.S Centre for Dental Studies and Research, Chaudhary Charan Singh University, Ghaziabad, Uttar Pradesh, 201206, India
| | - Shafait Ullah Khateeb
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
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45
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Twishi S, Anjuna R, Alisha A, Sukanya M, Vidhi J, Kumar AS, Amit G, Ankita C, Satyendra K, Deepak K, Srikanth S, Pankaj B, Ashwini A, Sanjeev M. Isolate profiling and geographical distribution of COVID-19 associated mucormycosis cases presenting to a tertiary care hospital in Jodhpur, India. Indian J Med Microbiol 2023; 46:100424. [PMID: 37638772 DOI: 10.1016/j.ijmmb.2023.100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND AND PURPOSE COVID-associated mucormycosis (CAM) was as a dreadful complication in India. The state of Rajasthan, reported remarkably more patients than others but the cause for such geographical variation was unclear. The demography, clinical presentation and pathogens of CAM were studied. METHODOLOGY This was a prospective observational study where tissue specimens from CAM patients were subjected to microscopy and culture. RESULTS AND CONCLUSION Out of 324 suspected CAM patients, the diagnosis was proven in 215 cases (66.36%). Culture was positive in 51.63% patients. Rhizopus arrhizus was the most common mucorale (82.88%) and rhino-orbital-cerebral (95.37%) was most common clinical presentation.
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Affiliation(s)
- Shrimali Twishi
- Department of Microbiology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Radhakrishnan Anjuna
- Department of Microbiology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Aggarwal Alisha
- Department of Microbiology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Mehrotra Sukanya
- Department of Microbiology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Jain Vidhi
- Department of Microbiology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India.
| | - Abhishek S Kumar
- Department of Microbiology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Goyal Amit
- Department of Otorhinolaryngology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Chugh Ankita
- Department of Dentistry, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Khichar Satyendra
- Department of General Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Kumar Deepak
- Department of General Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Srinivasan Srikanth
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Bharadwaj Pankaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Aggarwal Ashwini
- Department of Microbiology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Misra Sanjeev
- All India Institute of Medical Sciences Jodhpur, Rajasthan, India
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46
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Kulkarni P, Beeraka D, Tanwar M, Kim U, Ganesan RM, Saini P. Frontal osteomyelitis post-COVID-19 associated mucormycosis. Indian J Ophthalmol 2023; 71:2906-2910. [PMID: 37417145 PMCID: PMC10491079 DOI: 10.4103/ijo.ijo_3117_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: 11/28/2022] [Revised: 04/11/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
Rhino-orbito-cerebral mucormycosis (ROCM) is the most commonly noted form of mucormycosis, which is the most common secondary fungal infection following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Osteomyelitis is one of the rare sequelae of ROCM, frontal osteomyelitis being the rarest. We present four patients of coronavirus disease 2019 (COVID-19)-associated mucormycosis, who presented with frontal bone osteomyelitis after being treated for ROCM surgically and medically. This is the first case series highlighting this complication in post-COVID-19 mucormycosis patients and needs utmost attention as it can be life-threatening and can cause extreme facial disfiguration. All four patients are alive with salvage of the affected globe and vision being preserved in one patient. If identified early, disfiguration of face and intracranial extension can be avoided.
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Affiliation(s)
- Pooja Kulkarni
- Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Deepika Beeraka
- Ophthalmology Resident, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Meghana Tanwar
- Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Usha Kim
- Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Pragya Saini
- Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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47
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Yeo S, Kim H, Lee J, Yi J, Chung YR. Retinal vascular occlusions in COVID-19 infection and vaccination: a literature review. Graefes Arch Clin Exp Ophthalmol 2023; 261:1793-1808. [PMID: 36598554 PMCID: PMC9811047 DOI: 10.1007/s00417-022-05953-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Abnormal hypercoagulability and increased thromboembolic risk are common in patients with coronavirus disease (COVID-19). COVID-19 has been suggested to cause retinal vascular damage, with several studies on COVID-19 patients with retinal vascular occlusions. We reviewed and investigated studies on retinal vascular occlusions in patients diagnosed with COVID-19 and in those vaccinated for COVID-19. METHODS Studies that reported retinal vascular occlusion in COVID-19 patients or in vaccinated people were identified using the terms "retinal occlusion," together with "severe acute respiratory syndrome coronavirus 2", "SARS-CoV-2," "COVID-19," "coronavirus," and "vaccine," through systematic searches of PubMed and Google Scholar databases until January 7, 2022. RESULTS Thirteen cases of retinal artery occlusion (RAO) and 14 cases of retinal vein occlusion (RVO) were identified among patients diagnosed with COVID-19. Half of the patients with RAO or RVO revealed no systemic disorders except current or past COVID-19, and ocular symptoms were the initial presentation in five cases. Among patients with RAO, most presented with central RAO at 1-14 days of COVID-19 diagnosis, with abnormal coagulation and inflammatory markers. Among those with RVO, two-thirds presented with central RVO and one-third with RVO. Eleven cases with acute macular neuroretinopathy (AMN) and/or paracentral acute middle maculopathy (PAMM) were reported among patients with COVID-19, presenting scotoma resolved spontaneously in most cases. Among the 26 cases vaccinated with either mRNA or adenoviral vector vaccines for COVID-19 and presenting retinal vascular occlusions, there were more RVO cases than RAO cases, and ocular symptoms mostly occurred within 3 weeks after vaccination. One case presented bilateral AMN and PAMM after COVID-19 vaccination. CONCLUSION Retinal vascular occlusions might be a manifestation of COVID-19, although rare, especially in patients at risk of systemic hypercoagulability and thromboembolism. For COVID-19 vaccines, the causal relationship is controversial because there are few case reports of retinal vascular occlusions after COVID-19 vaccination.
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Affiliation(s)
- Suji Yeo
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Korea
| | - Hanju Kim
- Special Study Module, Ajou University School of Medicine, Suwon, Korea
| | - Jiwon Lee
- Special Study Module, Ajou University School of Medicine, Suwon, Korea
| | - Jeonghyun Yi
- Special Study Module, Ajou University School of Medicine, Suwon, Korea
| | - Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Korea.
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48
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Kumari R, Talawar P, Tripaty DK, Singla D, Kaushal A, Sharma S, Malhotra M, Boruah P, Sangadala P, Kumar KS. A Retrospective Study to Evaluate the Perioperative Clinical Characteristics and Outcomes of Rhino-Orbital Cerebral Mucormycosis in COVID-19 Patients at a Tertiary Care Hospital in India. Cureus 2023; 15:e41613. [PMID: 37565105 PMCID: PMC10410089 DOI: 10.7759/cureus.41613] [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: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
Background and aims A descriptive analysis of patients who underwent surgical debridement for coronavirus disease 2019 (COVID-19) related mucormycosis was described, which aimed at the evaluation of perioperative clinical characteristics, perioperative complications, and outcomes. Methods We conducted a retrospective study on patients who underwent surgical intervention for mucormycosis during the COVID-19 pandemic at a tertiary care institute in India from March 1, 2021, to June 30, 2021. The medical records of 92 patients were reviewed and analyzed. Results There was a male predominance with a mean age of 50.86 years. The most common comorbidity was diabetes mellitus (DM) (98.9%). Intra-operative complications included hypotension, hyperglycemia, and hypokalemia. Most of the patients (88%) were extubated inside the operation theater, and 48% of patients had mortality. Serum ferritin levels, computed tomography severity score (CTSS), and D-dimers were significantly high in the patient who had mortality. Conclusion The perioperative mortality in patients with COVID-19 associated mucormycosis was very high. DM was the most common comorbidity followed by hypertension. Pre-operative elevated serum ferritin, D-dimer, and high CTSS were associated with higher mortality; hypokalemia, followed by hypocalcemia, was the most common perioperative and post-operative electrolyte imbalance. Thorough pre-operative optimization, multidisciplinary involvement, and perioperative care are of the utmost importance to decrease mortality and improve outcomes.
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Affiliation(s)
- Rekha Kumari
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Praveen Talawar
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Debendra K Tripaty
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Deepak Singla
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Ashutosh Kaushal
- Anaesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Sameer Sharma
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Manu Malhotra
- Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Priyanka Boruah
- Anaesthesiology, State Cancer Institute, Guwahati, Guwahati, IND
| | - Priyanka Sangadala
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Karthikeyan S Kumar
- Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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49
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Jayagayathri R, Ezhilvathani N, Venkatesh R. Knowledge, attitude, and practice toward mucormycosis among patients discharged from a COVID-19 care tertiary center in South India: A questionnaire-based survey. Indian J Ophthalmol 2023; 71:2818-2821. [PMID: 37417127 PMCID: PMC10491084 DOI: 10.4103/ijo.ijo_131_23] [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: 01/14/2023] [Revised: 03/18/2023] [Accepted: 04/07/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To study the awareness of mucormycosis among discharged inpatients after receiving treatment for COVID-19 infection at a tertiary COVID care center in south India. Methods This was a telephone-based survey conducted using a questionnaire consisting of 38 questions in five sections in the month of June-July 2021. COVID-positive inpatients who had been admitted, treated, and discharged from a government medical college were contacted via phones, and their responses were directly entered into the Google Forms platform. Results A total of 222 participants were included in the study. Among all the participants, a cumulative 66% of participants had some knowledge of mucormycosis and 98/222 (44%) did not have any idea of mucormycosis in spite of being admitted to the hospital. More than 40% of them reported that their prime source of information was through mass communication. Around 81% of the respondents were aware that it can occur after COVID-19 infection. Among them, only 25 knew that systemic steroids were the main risk factor. Sixty-four out of 124 knew that diabetes is a major risk factor. Fifty percent agreed that a vaccine for COVID can prevent mucormycosis. Conclusion Such knowledge, attitude, and practice (KAP) studies give us an idea of the impact of the measures taken for educating the public. In this study, a cumulative 66% of participants had some knowledge of mucormycosis and 34.7% were diabetics who had better knowledge and practice scores than non-diabetics. Sixty-six point nine percent felt that it was possible to prevent this condition.
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Affiliation(s)
| | - Namaskaram Ezhilvathani
- Department of Ophthalmology, Indira Gandhi Medical College and Research Institute, Pondicherry, India
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50
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Muthu V, Agarwal R, Chakrabarti A. COVID-19, mucormycosis, and the cow: Damned lies! Indian J Med Microbiol 2023; 44:100382. [PMID: 37356841 PMCID: PMC10208110 DOI: 10.1016/j.ijmmb.2023.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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