Are Low Serum Vitamin D Levels a Risk Factor for Advent of COVID-19 Associated Rhinocerebral Mucormycosis: A Preliminary Case Control Study

To determine whether low serum vitamin D level is a risk factor for development of Rhinocerebral mucormycosis in COVID-19 afflicted patients. A case control study was conducted in a tertiary care hospital utilizing the archived records of COVID-19 afflicted Rhinocerebral mucormycosis cases and age and gender matched controls. The mean value (± standard deviation) of vitamin D level in patients with Mucormycosis was 19.65 ± 13.07 ng/ml and in control subjects it was 27.88 ± 18.04 ng/ml.There was a significant difference between groups (p = 0.02). Thus, low Vitamin D level may be implicated as a risk factor for the advent of mucormycosis in a COVID-19 afflicted patient and therefore Vitamin D supplements may be provided to such patients to achieve normal serum levels.

Reducing mortality in mucormycosis of the head and neck in diabetic patients: A CARE case series

INTRODUCTION

Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality.

CASE SUMMARY

We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control.

DISCUSSION

Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.

Rhinocerebral mucormycosis: a retrospective study

Mucormycosis is an acute often fatal infection caused by fungi of family mucoracea (Kauffman and Malani Curr Infect Dis Rep 9(6):435-440). The principal pathogens in this family are rhizopus, mucor and absidia species. Mucoracea are found in soil, decaying vegetation and other organic matter. Mucormycosis is a polymorphic disease with diverse clinical manifestation. It is divided into rhinocerebral, pulmonary, cutaneous, cardiac, gastrointestinal and disseminated. Rhinocerebral mucormycosis the most commonest manifestation of mucormycosis is usually a fatal fulminant infection. Rhinocerebral mucormycosis can be further divided into rhino-maxillary and rhino-orbito-cerebral. The disease commonly occur in diabetics who have ketoacidosis but is also seen in severely debilitated or immunosuppressed patients. It has also been reported from otherwise normal individuals. Early diagnosis and treatment is mandatory for a successful management of this infection.

Rhinocerebral mucormycosis: A deadly disease on the rise

According to WHO, there will be epidemic of diabetes world over and India is going to be 'A diabetes capital of the world' by 2025. With the increasing incidence of diabetes, the associated complications are also bound to increase. Rhinocerebral mucormycosis is one of them.Rhinocerebral Mucormycosis is an opportunistic, fulminating fungal infection, caused by Rhizopus species of order of mucorales, frequently seen in diabetic and immunocompromised patients. Mucormycosis has a very high mortality rate.Early diagnosis and treatment with Amphotericin-B is the key to combat this disease successfully. We have seen 13 cases in last 3 years (2002-2005) in our area. This incidence is significant, as this type of cases were rarely seen before 2002, in this geographical area. We present an account of these cases; treatment strategies adopted, review of literature, and highlight 'the role of ENT surgeon in diagnosis and management of this dreadful disease'.