1
|
Chakraborty S, Satty SR, Sahu BK, Ray S. Resurgence of orbital mucormycosis during COVID-19 pandemic: Study from a tertiary care center in Eastern India. Taiwan J Ophthalmol 2024; 14:256-261. [PMID: 39027069 PMCID: PMC11253996 DOI: 10.4103/tjo.tjo-d-23-00110] [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: 07/20/2023] [Accepted: 10/16/2023] [Indexed: 07/20/2024] Open
Abstract
PURPOSE A sudden surge of Mucormycosis cases during the second wave of Covid 19 was observed in certain parts of India. The reasons for this upsurge remain unknown. However its impact on the overall healthcare system was quite overwhelming. In this context this study was decided to estimate and assess the spectrum of orbital involvement in patients with Mucormycosis, to find its association with coexisting disease entities if any, and at the same time evaluate the therapeutic response to established treatment regimens. MATERIALS AND METHODS This descriptive longitudinal study was conducted over a period of six months. Patients presenting with symptoms of Mucormycosis were jointly evaluated by a multi speciality team. After confirmation of diagnosis, patients were treated with intravenous Amphotericin B, surgical debridement of affected sinuses and orbital exenteration when indicated. They were followed up for three months after discharge. RESULTS Forty-three patients were enrolled in this study. Thirty-seven (86.04%) were COVID positive. All of them had history of steroid exposure during COVID treatment. Ninety five percent of study participants had diabetes mellitus. Twenty-seven (62.79%) patients had orbital involvement. Most common clinical presentation was peri-orbital or facial pain and edema. Besides medical treatment, thirty-nine patients (90.69%) required sinus debridement and nine patients (20.9%) required orbital exenteration. Thirteen patients (30.23%) expired during the follow up period. With treatment disease regressed in twenty patients (46.51%). CONCLUSION Diabetes and use of steroids to prevent anticipated cytokine storm may be the inciting factors for Orbital Mucormycosis in COVID patients. Early diagnosis, treatment and control of risk factors are keys for recovery and survival..
Collapse
Affiliation(s)
- Soumen Chakraborty
- Department of Ophthalmology, Deben Mahato Government Medical College, Purulia, West Bengal, India
| | | | - Badal Kumar Sahu
- Department of General Medicine, NRS Medical College, Kolkata, India
| | - Soumya Ray
- Department of Ophthalmology, Bankura Sammilani Medical College, Bankura, West Bengal, India
| |
Collapse
|
2
|
Nair KS, Alagesan M, Jose D, Yoganathan C, Saravanan R, Karthikeyan K, Divya K, Babu D, Rajan C, Pappachan JM. Clinical Profile and Factors Associated with Adverse Outcomes in Coronavirus Disease 2019-associated Mucormycosis: A Single-centre Study. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:73-79. [PMID: 38187078 PMCID: PMC10769467 DOI: 10.17925/ee.2023.19.2.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/04/2023] [Indexed: 01/09/2024]
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic was associated with an increased incidence of mucormycosis globally. However, the clinical pattern, epidemiologic features and risk factors for adverse outcomes are not well established. Methods: We performed a retrospective analysis of the data from patients hospitalized with proven mucormycosis between April 2021 and August 2021. Patients were managed with a multi-disciplinary approach involving medical, surgical, and comorbidity treatment. The clinical presentation, management details, complications and outcomes, including mortality, were reviewed from clinical records. Results: The mean age of presentation was 53.7 (± 11.8) years, and 88 (84.6%) were men. Of the 104 cases with COVID-19-associated mucormycosis, 97 (93.27%) patients had diabetes, and 80.8% had a haemoglobin A1C (HbA1c) of ≥6.4% at diagnosis. Seventy percent of diabetes cases experienced steroid-induced hyperglycaemia during treatment. Even with appropriate treatment, 17 (16.35%) patients died. High HbA1c and creatinine levels, presence of chronic kidney disease (CKD), need for intensive care unit admission, and orbital evisceration were the risk factors associated with high mortality on multivariate logistic regression analysis. Cox regression analysis revealed that the overall mortality increased by a factor of 12% with each 1 percentage point increase in HbA1c ≥6.4% (hazard ratio 1.12; 95% confidence interval 0.95- 1.31). The mortality risk was even higher when diabetes was associated with CKD (hazard ratio 1.82; 95% confidence interval 0.24-14.00). Conclusion: High HbA1c and creatinine levels, intensive care unit admission, CKD, and aggressive disease requiring orbital evisceration are the predictors of mortality in patients with COVID-19-associated mucormycosis. Patients with these risk factors should be managed more actively to reduce morbidity and mortality.
Collapse
Affiliation(s)
- Krishna S Nair
- Department of General Medicine, PSG Institute of Medical Sciences and Research Center, Coimbatore, India
| | - Murali Alagesan
- Department of General Medicine, PSG Institute of Medical Sciences and Research Center, Coimbatore, India
| | - Dhanya Jose
- Department of Community Medicine, Goa Medical College, Goa, India
| | - Chidambaram Yoganathan
- Department of General Medicine, PSG Institute of Medical Sciences and Research Center, Coimbatore, India
| | | | | | - Karuppannasamy Divya
- Department of Opthalmology, PSG Institute of Medical Sciences and Research Center, Coimbatore, India
| | - Dinesh Babu
- Department of Dental Surgery, PSG Institute of Medical Sciences and Research Center, Coimbatore, India
| | - Cyril Rajan
- Department of General Medicine, PSG Institute of Medical Sciences and Research Center, Coimbatore, India
| | - Joseph M Pappachan
- Department of Medicine & Endocrinology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Faculty of Science, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
3
|
Al Balwi WM, AlGhamdi N, Alshahrani R, Abdelrahman IH, Mahmoud S, Al-Hamad A, Al Hamzah S, Al Jraid F, Al Turki M, Al Balwi MA. Risk factors predicting disease severity and mortality in coronavirus disease 2019 Saudi Arabian patients. Ann Thorac Med 2023; 18:98-102. [PMID: 37323375 PMCID: PMC10263073 DOI: 10.4103/atm.atm_435_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/20/2023] [Indexed: 06/17/2023] Open
Abstract
CONTEXT Coronavirus disease 2019 (COVID-19) became a global pandemic that may be associated with significant associated risk factors. AIMS The aim of this study was to evaluate the factors predisposing risk to death in COVID-19 patients. SETTINGS AND DESIGN This is a retrospective study that presents the demographic, clinical presentation, and laboratory findings on our patients to determine risk factors contributing to their COVID-19 outcome. METHODS We used logistic regression (odds ratios) to examine associations between clinical findings and risk of death in COVID-19 patients. All analyses were done using STATA 15. RESULTS A total of 206 COVID-19 patients were investigated, 28 of them died, and 178 survived. Expired patients were older (74.04 ± 14.45 vs. 55.56 ± 18.41 in those who survived) and mainly of male gender (75% vs. 42% in those who survived). The following factors were strong predictors of death: hypertension (OR: 5.48, 95% CI: 2.10-13.59, P < 0.001), cardiac disease (OR: 5.08, 95% CI: 1.88-13.74, P = 0.001), and hospital admission (OR: 39.75, 95% CI: 5.28-299.12, P < 0.001). In addition, blood group B was more frequent in expired patients (OR: 2.27, 95% CI: 0.78-5.95, P = 0.065). CONCLUSIONS Our work adds to the current knowledge about the factors predisposing to death in COVID-19 patient. In our cohort, expired patients were of older age and male gender plus they were more likely to have hypertension, cardiac disease, and hospital severe disease. These factors might be used to evaluate risk of death in patients recently diagnosed of COVID-19.
Collapse
Affiliation(s)
- Wala M. Al Balwi
- Department of Clinical Nutrition, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nouf AlGhamdi
- Department of Clinical Nutrition, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reem Alshahrani
- Department of Clinical Nutrition, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ihssan H. Abdelrahman
- Department of Clinical Nutrition, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sami Mahmoud
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ali Al-Hamad
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Salma Al Hamzah
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Al Jraid
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Maha Al Turki
- Department of Clinical Nutrition, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed A. Al Balwi
- King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Pathology, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Watanabe A, So M, Mitaka H, Ishisaka Y, Takagi H, Inokuchi R, Iwagami M, Kuno T. Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis. Mycopathologia 2022; 187:271-289. [PMID: 35312945 PMCID: PMC8935886 DOI: 10.1007/s11046-022-00627-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/09/2022] [Indexed: 12/15/2022]
Abstract
The recent increase of COVID-19-associated mucormycosis (CAM) has been commanding global attention. However, basic epidemiologic characteristics have not firmly been established. In this systematic review and meta-analysis, we sought to determine the clinical manifestations, potential risk factors, and outcomes of CAM. Observational studies reporting CAM were searched with PubMed and EMBASE databases in January 2022. We collected data on comorbidities and treatment for COVID-19, and performed a one-group meta-analysis on the frequency of orbital exenteration procedure and mortality of CAM using a random-effect model. Fifty-one observational studies, including a total of 2,312 patients with proven CAM, were identified. Among the 51 studies, 37 were conducted in India, 8 in Egypt, and 6 in other countries. The most common comorbidity was diabetes mellitus (82%). While 57% required oxygenation, 77% received systemic corticosteroids. Among CAM, 97% were rhino-orbital-cerebral (ROCM), and 2.7% were pulmonary mucormycosis. Usual presentations were headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%). Regarding the outcomes, orbital exenteration was performed in 17% (95% CI: 12–21%, I2 = 83%) of the COVID-19-associated ROCM patients. The mortality of CAM was 29% (95% CI; 22–36%, I2 = 92%). In conclusion, this systematic review and meta-analysis indicated that the most prevalent type of CAM was ROCM, and most CAM patients had diabetes mellitus and received systemic glucocorticoids. Clinicians in the endemic areas should have a high index of suspicion for this invasive fungal complication of COVID-19 when a diabetic patient who received high-dose systemic glucocorticoids developed rhino-orbital symptoms.
Collapse
|