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Coronavirus-associated mucormycosis: different from sinonasal mucormycosis. J Laryngol Otol 2022; 136:1296-1303. [DOI: 10.1017/s002221512200161x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AbstractObjectiveTo study unusual presentations of coronavirus-associated mucormycosis that are rarely seen in sinonasal mucormycosis cases.MethodThe data of 400 rhino-orbito-cerebral mucormycosis patients admitted to Sawai Man Singh Hospital, Jaipur, from May 2021 to June 2021, were retrospectively collected. The diagnosis of mucormycosis was made by histological examination of biopsy samples.ResultsOut of 400 patients, 62 had symptoms other than common symptoms of rhino-orbito-cerebral mucormycosis. Thirty-four patients had facial palsy, 19 complained of gum ulcers, 6 developed a cheek abscess, 2 complained of maggots in the nose along with common rhino-orbito-cerebral mucormycosis symptoms, and 1 had a cerebellar infarct.ConclusionMucormycosis is a disease with various presentations, and coronavirus-associated mucormycosis has added unusual presentations to the existing list of manifestations of rhino-orbito-cerebral mucormycosis. In this coronavirus disease era, mucormycosis should always be considered as a diagnosis in patients with these unusual presentations.
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Kumar M, Alagarsamy R, Madi M, Pentapati KC, Vineetha R, Shetty SR, Sharma A. Rhinocerebral mucormycosis: a systematic review of case reports and case series from a global perspective. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:708-716. [PMID: 36184407 DOI: 10.1016/j.oooo.2022.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/03/2022] [Accepted: 06/11/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Rhinocerebral mucormycosis (RCM) is the most common variant and the presenting features in the head and neck region are seldom pathognomonic. The aim of this systematic review was to obtain a thorough insight into the predisposing factors, clinical features, disease course, management protocol, outcome, and prognosis. STUDY DESIGN An electronic search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Web of Science, and EMBASE databases. Articles in which the clinical findings on the extra- and intraoral features of RCM were included for systematic review. Descriptive statistics was applied to obtain the results. RESULTS A total of 124 case studies (90 case reports, 34 case series) which yielded 219 patients. Diabetes mellitus (57.40%) was the most common comorbid condition. Neurologic manifestations were noted in 23.3% of the individuals. Maxillary/hard palate involvement was a common occurrence (59.2%). Intra-oral necrotic lesions with eschar were noted in 75/219 patients. Amphotericin B was the commonly used drug for the management, and surgical debridement was performed in majority of the cases. The mortality rate was 18.4%. CONCLUSIONS The clinical manifestations often mimic odontogenic symptoms, hence a sound knowledge about the pathogenesis and course of the disease will aid in the prompt diagnosis and management.
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Affiliation(s)
- Mathangi Kumar
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ragavi Alagarsamy
- Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Medhini Madi
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Kalyana Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravindranath Vineetha
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shishir Ram Shetty
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, United Arab Emirates
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Post Covid-19 Acute Invasive Fungal Rhinosinusitis (AIFR): A Study of Histopathological Findings After FESS in Radiologically Diagnosed AIFR. Indian J Otolaryngol Head Neck Surg 2022; 75:689-695. [PMID: 36373121 PMCID: PMC9638194 DOI: 10.1007/s12070-022-03250-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
COVID-19 pandemic has led to a concerning surge of post-COVID-19 AIFR. Mucormycosis (BLACK fungus) is a rare but severe and life-threatening fungal infection occurred by mucormycetes, a family of moulds. More than 49,000 cases of AIFR were reported in three months in India. It primarily affects diabetics and spreads from the nasal cavity and paranasal sinuses (PNS). It also involves eye, palate, or brain. It is diagnosed clinically followed by radiological and pathological findings. We aimed to compare and analyse the pre-operative imaging with postoperative histopathological findings. The study was conducted in ENT department of tertiary care hospital, Rajkot. 200 patients were randomly selected who were presented to ENT OPD with clinically suspected Post COVID-19 AIFR. All patients underwent detailed ENT examination and radiological modality like MRI PNS, Brain, and Orbit. After proper pre-op evaluation, all patients underwent Functional Endoscopic Sinus Surgery (FESS). MRI findings were confirmed with that of histopathological findings done on KOH mount. All the patients were showing AIFR on MRI findings whereas 49% of patients had mucormycosis on Histopathology. Various other fungal infections like aspergillosis (7%), candidiasis (1.5%) were also found on HPE. 9% of patients showed combined infection with mucor and aspergillus species. Rest of the patients showed non-fungal rhinosinusitis. Inflow of the epidemic, plenty of patients were shown invasive fungal sinusitis in MRI patterns whereas many of them were HPE negative. Thus this study was done to know the efficacy of radiological features with pathological diagnosis. We have considered both procedures standard in our study.
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Sharma S, Sharma AK, Amreen, Singhal P, Poonia A, Agrawal S, Jat KS, Sharma MP. Sublabial Approach Versus Modified Denker's Procedure: A Comparative Study of Pre-maxillary Tissue Clearance in Covid-Associated Mucormycosis. Indian J Otolaryngol Head Neck Surg 2022; 74:3252-3258. [PMID: 36452567 PMCID: PMC9702130 DOI: 10.1007/s12070-021-03060-3] [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: 10/09/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022] Open
Abstract
To compare the efficacy of the sublabial and modified Denker's procedure in clearance of fungal disease from the anterior wall of maxilla and the pre-maxillary area i.e. the difficult areas of maxillary sinus. A prospective observational study was conducted over a period of 2 months (April 21-June 21) in the ENT department of Sawai Man Singh hospital, Jaipur. All the patients with clinical involvement of the premaxilla or the cheek abutting the anterior wall of maxilla were included in the study population. Cases matched in both groups were subjected to debridement either by the sublabial or the modified denker's approach. Outcomes were measured by assessing the daily CRP values, post-operative DNE every 3 days after pack removal, and imaging at the end of 1 month. Repeat biopsies were performed in patients that still had persistent symptoms after getting operated on. 16 of the 60 patients (26.6%) operated on by the endoscopic approach showed evidence of residual disease on follow-up whereas only 5 patients (9.6%) in the other category had a similar outcome. Most of the recidivism was seen in the anterior maxilla. Lower rates of complications were found following debridement by the sublabial approach. Since the sublabial approach is the most direct approach for the key areas of fungal involvement of maxillary sinus, it is recommended over the modified Denker's procedure for disease clearance from pre maxilla and the anterior wall of maxillary sinus. This view is also supported by the lower rates of complications encountered following the former.
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Affiliation(s)
- Shivam Sharma
- Department of Otolaryngology and Head and Neck Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Anjani Kumar Sharma
- Department of Otolaryngology and Head and Neck Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Amreen
- Department of Otolaryngology and Head and Neck Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan 302004 India
- No. 115, Shastri Colony, Opposite to A. S. Sen. Sec. School, Talwara Road, Mukerian district, Hoshiarpur, Punjab India
| | - Pawan Singhal
- Department of Otolaryngology and Head and Neck Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Ashok Poonia
- Department of Otolaryngology and Head and Neck Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Shubham Agrawal
- Department of Otolaryngology and Head and Neck Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Kailash Singh Jat
- Department of Otolaryngology and Head and Neck Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Man Prakash Sharma
- Department of Otolaryngology and Head and Neck Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan 302004 India
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Gautam M, Soni M, Bhaisare V, Rawat P, Walia S, Kori N. Complete and incomplete lower motor neuron facial palsy in post-COVID-19 mucormycosis. Indian J Ophthalmol 2022; 70:1365-1370. [PMID: 35326056 PMCID: PMC9240573 DOI: 10.4103/ijo.ijo_2736_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To study facial nerve palsy (FNP) in post-COVID-19-mucormycosis patients and its ocular complications, report different presentations of FNP in such patients, and propose its etiopathogenesis based on presentation and clinico-radiologic localization. Methods: A prospective cohort study was carried out in patients of post-COVID-19-mucormycosis who presented at our tertiary center, over a period of 3 months. Motor and sensory examination of the facial nerve was done to diagnose FNP and localize the lesion clinically. Slit-lamp examination was done for grading corneal involvement. MRI brain, orbit, and paranasal sinuses (PNS) with contrast were studied to find involvement along the facial nerve. It was assessed whether this site of lesion corresponded with clinical localization. Data were analyzed using the percentage of total cases and Fisher’s test. Results: A total of 300 patients with post-COVID-19 mucormycosis were examined, of which 30 (10%) patients were found to have FNP. All were lower motor neuron (LMN) type and were associated with corneal complications. The most common site clinically was distal to the chorda tympani (66.66%) and radiologically was infratemporal (IT) fossa (63.4%). The clinical localization significantly correlated with the radiological findings (P = 0.012). Twenty percent of patients showed incomplete involvement of facial muscles Conclusion: FNP was found to be of LMN type. The most common site of insult was IT fossa. There was a good clinico-radiological correspondence of lesions. Isolated lesions were also found along the peripheral nerve course, presenting as incomplete facial palsy. Recognition of FNP in post-COVID-19 mucormycosis, in all its variable forms, is important to manage corneal complications.
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Affiliation(s)
- Manushree Gautam
- Department of Ophthalmology, MGM Medical College, Indore, Madhya Pradesh, India
| | - Meenal Soni
- Department of Ophthalmology, MGM Medical College, Indore, Madhya Pradesh, India
| | - Vijay Bhaisare
- Department of Ophthalmology, MGM Medical College, Indore, Madhya Pradesh, India
| | - Preeti Rawat
- Department of Ophthalmology, MGM Medical College, Indore, Madhya Pradesh, India
| | - Shweta Walia
- Department of Ophthalmology, MGM Medical College, Indore, Madhya Pradesh, India
| | - Neetu Kori
- Department of Ophthalmology, MGM Medical College, Indore, Madhya Pradesh, India
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Deb A, Pathak P, Sreedharan S, Rao ACK, Patil V. A rare case of parotid mucormycosis diagnosed on aspiration cytology. Diagn Cytopathol 2021; 49:552-554. [PMID: 33554465 DOI: 10.1002/dc.24719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Arunima Deb
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Priya Pathak
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Suja Sreedharan
- Department of Otorhinolaryngology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | | | - Vinuta Patil
- Department of Otorhinolaryngology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Mane R, Patil B, Mohite A, Mohanty R. Facial Nerve Palsy: An Unusual Presentation in Patients with Rhino Cerebral Mucormycosis. Indian J Otolaryngol Head Neck Surg 2018; 71:2110-2113. [PMID: 31763303 DOI: 10.1007/s12070-018-1530-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/08/2018] [Indexed: 11/28/2022] Open
Abstract
The aim of this study is to highlight involvement of facial nerve as a presenting symptom in rhino cerebral mucormycosis. A retrospective longitudinal study was carried out for a period of 1 year from May 2017 to May 2018 in Department of Otorhinolaryngology of Dr. D. Y. Patil Medical College and Hospital, Kolhapur. The usual presentation include nasal stuffiness, headache, eye pain and orbital swelling, ophthalmoplegia and visual loss. However we had four patients who presented to our OPD with facial nerve palsy and rhino cerebral mucormycosis. All four patients were diabetic. The available clinical and laboratory data was retrospectively collected and analyzed. Facial nerve palsy is an unusual but significant sign in presentation of mucormycosis. It could be misdiagnosed as CVA with subsequent delay in the treatment. A high index of suspicion for mucormycosis in diabetic patients presenting with facial palsy will be helpful in achieving early and accurate diagnosis with prompt management and better outcome.
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Affiliation(s)
- Rajashri Mane
- Department of Otorhinolaryngology, Dr. D. Y. Patil Medical College and Hospital, Kolhapur, India
| | - Balasaheb Patil
- Department of Otorhinolaryngology, Dr. D. Y. Patil Medical College and Hospital, Kolhapur, India
| | - Anjana Mohite
- Department of Otorhinolaryngology, Dr. D. Y. Patil Medical College and Hospital, Kolhapur, India
| | - Roshni Mohanty
- Department of Otorhinolaryngology, Dr. D. Y. Patil Medical College and Hospital, Kolhapur, India
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