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Patil R, Mukhida S, Ajagunde J, Khan U, Khan S, Gandham N, Vyawhare C, Das NK, Mirza S. Development of a machine learning model to predict risk of development of COVID-19-associated mucormycosis. Future Microbiol 2024; 19:297-305. [PMID: 38294306 DOI: 10.2217/fmb-2023-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Aim: The study aimed to identify quantitative parameters that increase the risk of rhino-orbito-cerebral mucormycosis, and subsequently developed a machine learning model that can anticipate susceptibility to developing this condition. Methods: Clinicopathological data from 124 patients were used to quantify their association with COVID-19-associated mucormycosis (CAM) and subsequently develop a machine learning model to predict its likelihood. Results: Diabetes mellitus, noninvasive ventilation and hypertension were found to have statistically significant associations with radiologically confirmed CAM cases. Conclusion: Machine learning models can be used to accurately predict the likelihood of development of CAM, and this methodology can be used in creating prediction algorithms of a wide variety of infections and complications.
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Affiliation(s)
- Rajashri Patil
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Sahjid Mukhida
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Jyoti Ajagunde
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Uzair Khan
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Sameena Khan
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Nageswari Gandham
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Chanda Vyawhare
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Nikunja K Das
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
| | - Shahzad Mirza
- Department of Microbiology, Dr DY Patil Medical College Hospital & Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune 18, India
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Meena V, Barath S, Singh S, Jakhar P, Patel T. Role of Imaging Spectrum Along With Other Diagnostic Modalities in Rhino-Orbital-Cerebral Mucormycosis (ROCM). Cureus 2024; 16:e53962. [PMID: 38469024 PMCID: PMC10926969 DOI: 10.7759/cureus.53962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES Rhino-orbito-cerebral mucormycosis (ROCM), a rare angio-invasive fungal infection, had become a major outbreak during the second wave of the coronavirus disease (COVID-19) pandemic in India, with over 28,000 reported cases. The purpose of this study was to describe the imaging spectrum of ROCM, which may prove useful in prompt diagnosis, considering its grave prognosis in populations with a high load of immunosuppressed patients (e.g., COVID-19, HIV-AIDS, etc.). MATERIAL AND METHODS Evaluation of the clinical data and imaging of patients with symptoms suspicious of mucormycosis of the craniofacial region was done. The diagnosis was made using computed tomography (CT) or magnetic resonance (MR) imaging, a biopsy, and culture. The data analysis was done using descriptive statistical methods. RESULTS The sample group consisted of a total of 36 patients ranging from 33 years to 75 years of age, out of which 31 (86.11%) were male and five (13.8%) were female. A total of 30 (83.33%) patients had a positive correlation with COVID-19 infection, and 29 (80.55%) patients had a positive correlation with diabetes. The major presenting complaints were facial pain and swelling (20 patients; 55.55%). The intracranial spread was seen in 14 (38.88%) patients. Our study demonstrated a mortality rate of 38.88% (14 patients). CONCLUSION ROCM, once considered to occur predominantly in diabetics, is increasingly being seen in other immunosuppressive patients, such as COVID-19. CT and MR imaging help provide an early diagnosis in conjunction with pathologic and microbiological correlations. Immediate correction of immunosuppression with the initiation of amphotericin B therapy combined with extensive and diligent surgical debridement of the diseased tissue is required.
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Affiliation(s)
| | - Sitaram Barath
- Radiology, Geetanjali Medical College & Hospital, Udaipur, IND
| | | | - Prateek Jakhar
- Radiodiagnosis, Geetanjali Medical College & Hospital, Udaipur, IND
| | - Tarang Patel
- Pathology, All India Institute of Medical Sciences (AIIMS) Rajkot, Rajkot, IND
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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. touchREV Endocrinol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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El Hakkouni A, Harrar S, Hachimi A, Mezouari M, Moutaj R. Rhino-Orbito-Cerebral Mucormycosis: A Challenging Case. Cureus 2023; 15:e44768. [PMID: 37809164 PMCID: PMC10557089 DOI: 10.7759/cureus.44768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Mucormycosis is a rare opportunistic fungal infection caused by Mucorales and associated with high mortality rates. Rhino-orbito-cerebral localization usually occurs in individuals with uncontrolled diabetes mellitus. We report the case of a 41-year-old male, with previously undiagnosed diabetes, who presented with unilateral facial extensive black eschar and signs of diabetic ketoacidosis. Cerebral magnetic resonance imaging showed left pansinusitis, left craniofacial edematous infiltrate, and left proptosis. A left internal temporal abscess was identified at an early pre-suppurative stage. Magnetic resonance angiography revealed total occlusion of the left intracranial internal carotid artery. A histopathological study of nasal mucosa biopsy suggested mucormycosis. According to the clinical presentation and the radiological and histopathological findings, rhino-orbito-cerebral mucormycosis was presumed. Culture of nasal, ocular, and skin lesion specimens grew Rhizomucor sp. and confirmed the diagnosis. The patient was treated with systemic liposomal amphotericin B. He died of multiple organ failure before surgical debridement was possible as he was in critical condition requiring stabilization before surgical treatment.
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Affiliation(s)
- Awatif El Hakkouni
- Parasitology-Mycology Laboratory, Mohammed VI University Hospital, Marrakech, MAR
| | - Sara Harrar
- Parasitology-Mycology Laboratory, Mohammed VI University Hospital, Marrakech, MAR
| | | | - Mostafa Mezouari
- Parasitology-Mycology Laboratory, Ibn Sina Military Hospital, Marrakech, MAR
| | - Redouane Moutaj
- Parasitology-Mycology Laboratory, Ibn Sina Military Hospital, Marrakech, MAR
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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B H S, Kumbhalkar S, Selvi K, G D, Bidkar V, Dabhekar S, Prathipati K, Sawal A. Sinonasal and Orbital Imaging Findings in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of COVID-19: A Retrospective Cohort Study in a Tertiary Hospital in Central India. Cureus 2023; 15:e42674. [PMID: 37649953 PMCID: PMC10463103 DOI: 10.7759/cureus.42674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Background Mucormycosis is a consequence of the angioinvasive disease caused by filamentous fungi that belong to the order Mucorales, particularly Mucor, Rhizopus, and Rhizomucor. Rhizopus oryzae is the most prevalent form. The invading hyphae lead to damage of blood vessels leading to thrombosis and consequent tissue necrosis. The incidence of this disease entity witnessed a significant rise during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. Timely diagnosis and prompt treatment are crucial to diminish both the mortality and morbidity associated with this disease. Imaging plays a pivotal role in diagnosing the ailment, evaluating its extent, identifying complications such as thrombosis, and facilitating surgical planning. It demonstrates exceptional sensitivity in detecting the disease at its early stages, often before symptoms manifest. Due to the angioinvasive nature of Mucor, early detection assumes utmost importance as it necessitates intensive antifungal therapy and the removal of devitalized tissue through debridement. Methodology We conducted a retrospective cohort study to analyze computed tomography (CT) imaging findings in patients with COVID-associated rhino-orbito-cerebral mucormycosis (ROCM) confirmed by histopathological examination. We compared these findings with CT findings of the nose and paranasal sinuses in patients without mucor following COVID-19 sinusitis (non-ROCM). Results All 16 cases in the non-ROCM group were in stage 1 disease. In contrast, in the ROCM group, three patients had stage 1 disease, five patients had stage 2 disease, and 10 patients had stage 3 disease (p = 0.0001). The pterygopalatine fossa was significantly affected in 10 of 18 ROCM patients and in none of the non-ROCM patients. Conclusions Imaging plays a crucial role in the early detection of mucormycosis. It assists treating physicians in initiating prompt and aggressive treatment, thereby improving the prognosis of this frequently fatal disease.
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Affiliation(s)
- Shrikrishna B H
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Sunita Kumbhalkar
- General Medicine, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Kalai Selvi
- Community Medicine, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Deepa G
- Anatomy, Datta Meghe Medical College, Nagpur, IND
| | - Vijay Bidkar
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Sandeep Dabhekar
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Kirankumar Prathipati
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Anupama Sawal
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Raj A, Nishant P, Sadhukhan K, Saha BC, Sinha U, Kokkayil P, Gupta A, Kumar A, Tiwari P. A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India. Indian J Ophthalmol 2023; 71:249-256. [PMID: 36588245 PMCID: PMC10155590 DOI: 10.4103/ijo.ijo_1699_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose To report the clinico-demographic profile of rhino-orbito-cerebral mucormycosis (ROCM) in patients during the "second wave" of the COVID-19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods Cross-sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID-19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID-19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty-six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion Our data from eastern India reinforces the relationship between COVID-19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.
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Affiliation(s)
- Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
| | - Prateek Nishant
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
| | - Kaushik Sadhukhan
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
| | - Bhawesh C Saha
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
| | - Upasna Sinha
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
| | - Prathyusha Kokkayil
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
| | - Abhishek Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences, Kalyani, Kalyani, West Bengal, India
| | - Amit Kumar
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
| | - Pragati Tiwari
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
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Yadav R, Madan S, Rohatgi J, Sahu PK, Das S, Tandon A, Rai P, Verma P, Singh J, Bajaj I. Corneal manifestations and treatment among patients with COVID-19-associated rhino-orbito-cerebral mucormycosis. Indian J Ophthalmol 2023; 71:101-108. [PMID: 36588217 PMCID: PMC10155557 DOI: 10.4103/ijo.ijo_1477_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose TO report the corneal manifestations in patients with COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM). Methods This study was a retrospective, observational, and record-based analysis of patients of ROCM with corneal involvement. Results A total of 220 patients were diagnosed with ROCM over a period of 3 months. Thirty-two patients had developed corneal manifestations. The mean age at diagnosis was 52.84 ± 12.8 years. The associated risk factors were systemic mucormycosis, uncontrolled diabetes, recent COVID-19 infection, and injudicious use of systemic steroids. Twenty-nine patients were known diabetics, 32 had recent COVID-19 infection, and 13 gave a history of injudicious use of steroids. The right eye (RE) was affected in nine patients, the left eye (LE) in 20 patients, and both eyes in three patients. Nine patients had a round-oval corneal ulcer. One patient each had a perforated corneal ulcer with uveal prolapse, sealed perforated corneal ulcer, spontaneously healed limbal perforation, diffuse corneal haze with hyphemia, panophthalmitis, diffuse corneal stromal abscess, limbal ischemia, anterior uveitis with posterior synechiae, inferior corneal facet, and filamentary keratitis. Three patients each had a corneal melt and inferior conjunctival xerosis with chemosis. Orbital exenteration was performed in six patients. Five patients with corneal ulcers healed. Topical eye drops of amphotericin (0.5 mg/ml) cycloplegic, antiglaucoma medications, and lubricant eye drops were started along with systemic antifungals. Conclusion Central corneal ulcer was the most common manifestation of mucormycosis. A concentration as low as 0.5 mg/ml of amphotericin eye drops was effective in the treatment.
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Affiliation(s)
- Rekha Yadav
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
| | - Siddharth Madan
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
| | - Jolly Rohatgi
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
| | - Pramod Kumar Sahu
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
| | - Anupama Tandon
- Department of Radiology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
| | - Puja Rai
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
| | - Priya Verma
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
| | - Jubin Singh
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
| | - Ishita Bajaj
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, Delhi, India
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Manesh A, Devasagayam E, Bhanuprasad K, Mathew SK, Karthik R, Mathew BS, Varghese GM. Efficacy of Crushed Delayed-Release Posaconazole Tablets in Rhino-Orbito-Cerebral Mucormycosis. Antimicrob Agents Chemother 2022; 66:e0108522. [PMID: 36377934 DOI: 10.1128/aac.01085-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A significant proportion of patients with Rhino-orbito-cerebral mucormycosis (ROCM) develop oroantral fistulas. Due to the unclear efficacy of crushed delayed-release posaconazole tablets (DRPT) via nasogastric tube in this group of patients, clinicians often use inferior alternatives like posaconazole suspension. In this prospective study, we report good plasma concentrations (median, 2,639 ng/mL; interquartile range [IQR], 1,690 to 3,575 ng/mL; and range, 1,004 to 4,835ng/mL) and complete cure and survival at 3 and 6 months in 19 such patients.
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Almyroudi MP, Akinosoglou K, Rello J, Blot S, Dimopoulos G. Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review. Diagnostics (Basel) 2022; 12:diagnostics12123092. [PMID: 36553099 PMCID: PMC9777018 DOI: 10.3390/diagnostics12123092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements.
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Affiliation(s)
- Maria Panagiota Almyroudi
- Department of Emergency Medicine, University Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, School of Medicine University of Patras, 26504 Rio, Greece
| | - Jordi Rello
- Vall d’Hebron Institute of Research, Barcelona, Spain & Clinical Research, CHU Nîmes, 30900 Nîmes, France
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane 4029, Australia
| | - George Dimopoulos
- 3rd Department of Critical Care, EVGENIDIO Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-6944756565
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Muacevic A, Adler JR, Thwe H, Alam B, Awosika AO, Omole AE. Rhino-Orbital Cerebral Mucormycosis in a Non-diabetic Patient Following COVID-19 Infection: A Case Report and Literature Review. Cureus 2022; 14:e32884. [PMID: 36699798 PMCID: PMC9867915 DOI: 10.7759/cureus.32884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
Rhino-orbital cerebral mucormycosis has been commonly seen during the coronavirus disease 2019 (COVID-19) pandemic. Several factors responsible for etiology and pathophysiology have been identified, among which corticosteroids and diabetes have contributed to the lion's share of the outbreak of mucormycosis. In this report, we discuss a case of a 41-year-old non-diabetic male with a recent convalescence from COVID-19 infection presented with gradual vision loss and loss of sensations in his right eye. He was found to have periorbital swelling, restriction of extraocular movements in all gazes, chemosis, ptosis of the right eye, and right maxillary sinus tenderness. His serum investigations, radiologic findings, and blood culture were indicative of rhino-orbital cerebral mucormycosis. He was started on systemic liposomal amphotericin B immediately and underwent aggressive surgical debridement. A high index of clinical suspicion, aggressive multifaceted management, and follow-up are needed to have successful outcomes, thereby lowering the morbidity of coronavirus-associated mucormycosis.
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Karat S, Lobo AC, Satish D, Devaraj R, Manjooran RR, Nithyanandam S. Uncontrolled diabetes mellitus exacerbated by COVID-19-induced inflammation is the risk factor for COVID-19-associated rhino-orbito-cerebral mucormycosis: A matched pair case-control study. Indian J Ophthalmol 2022; 70:3096-3101. [PMID: 35918980 DOI: 10.4103/ijo.ijo_448_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, India experienced an epidemic of COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to describe the epidemiology and elucidate the risk factors for developing COVID-19-associated ROCM, comparing the risk factors among COVID-19 patients with and without ROCM. Methods This case-control study included all COVID-19-associated ROCM patients treated at our hospital from May 1 to July 30, 2021. Controls included age- and sex-matched COVID-19 patients without ROCM, who were treated during the same time (exact matching, in 1:2 ratio). Matched pair analysis using conditional logistic regression was performed to examine the association of various risk factors with the development of ROCM in COVID-19 patients. Results The study included 69 patients with COVID-19-associated ROCM and 138 age- and gender-matched controls. Epidemiologically, COVID-19-associated ROCM predominantly affected males (59/69, 85%), in their early 50s (mean 52 years), with 48% (33/69) of patients being from medical resource-constrained settings. On multivariate conditional logistic regression, elevated serum glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.03-1.78), blood glucose (OR = 1.008, 95% CI: 1.003-1.013), and C-reactive protein (CRP) (OR = 1.07, 95% CI: 1.02-1.17) were associated with increased odds of developing COVID-19-associated ROCM. Patients with undetected diabetes mellitus with increasing HbA1c (OR = 3.42, 95% CI: 1.30-9.02) and blood glucose (OR = 1.02, 95% CI: 1.005-1.03) (P = 0.02) had a higher probability of developing COVID-19-associated ROCM than patients with established DM. Conclusion Uncontrolled DM evidenced by elevated HbA1c and blood glucose levels, exacerbated by COVID-19-induced proinflammatory state indicated by elevated CRP, is the principal independent risk factor for COVID-19-associated ROCM. Middle-aged males with undetected DM, from a resource-constraint setting, are particularly at risk.
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Affiliation(s)
- Shubashree Karat
- Department of Ophthalmology, St. John's Medical College, Bangalore, Karnataka, India
| | - Aaron C Lobo
- Department of Internal Medicine, St. John's Medical College, Bangalore, Karnataka, India
| | - Deepthi Satish
- Department of Otorhinolaryngology, St. John's Medical College, Bangalore, Karnataka, India
| | - Rincy Devaraj
- Department of Ophthalmology, St. John's Medical College, Bangalore, Karnataka, India
| | - Riya R Manjooran
- Department of Ophthalmology, St. John's Medical College, Bangalore, Karnataka, India
| | - Suneetha Nithyanandam
- Department of Ophthalmology, St. John's Medical College, Bangalore, Karnataka, India
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Pasternak M, Olszanecki R. Mucormycosis in head and neck area - the emerging health problem in COVID-19 pandemic. The perspective of a dental practitioner. Folia Med Cracov 2021; 61:117-127. [PMID: 34510169 DOI: 10.24425/fmc.2021.137228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mucormycosis is an invasive fungal disease caused by saprophytic molds and is characterized by a fulminant course and high mortality. Reported increase of disease cases and more frequent mucormycosis superinfections in COVID-19 patients are of a serious concern. Head and neck area is the most typical location of mucormycosis and often the first symptoms are eminent in oral cavity, therefore a dentist may be the first healthcare practitioner to recognize signs of this dangerous and potentially fatal disease. Urgent diagnosis and implementation of appropriate treatment are essential for the patient's survival. The dentist's participation in postoperative care is necessary and due to the destructive nature of radical surgical treatment, prosthetic rehabilitation is required to improve the patient's function and quality of life. Furthermore the vigilance of dentists will also allow early recognition of frequent recurrences of this insidious infection.
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Affiliation(s)
- Marcin Pasternak
- Chair of Pharmacology, Jagiellonian University Medical College, Kraków, Poland.
| | - Rafał Olszanecki
- Chair of Pharmacology, Jagiellonian University Medical College, Kraków, Poland
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14
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Bhattacharyya A, Sarma P, Sharma DJ, Das KK, Kaur H, Prajapat M, Kumar S, Bansal S, Prakash A, Avti P, Thota P, Reddy DH, Gautam BS, Medhi B. Rhino-orbital-cerebral-mucormycosis in COVID-19: A systematic review. Indian J Pharmacol 2021; 53:317-327. [PMID: 34414911 PMCID: PMC8411962 DOI: 10.4103/ijp.ijp_419_21] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Since the onset of COVID-19 pandemic, parallel opportunistic infections have also been emerging as another disease spectrum. Among all these opportunistic infection, mucormycosis has become a matter of concern with its rapid increase of cases with rapid spread as compared to pre-COVID-19 era. Cases have been reported in post-COVID-19-related immune suppression along with the presence of comorbidity which adds on the deadly outcome. There is no systematic review addressing the issue of COVID-19-associated mucormycosis. This is the first systematic review of published studies of mucormycosis associated with COVID-19. The aim was to analyze the real scenario of the disease statement including all the published studies from first November 2019 to 30th June to analyze the contemporary epidemiology, clinical manifestations, risk factor, prognosis, and treatment outcome of COVID-19 associated rhino-orbito-cerebral-mucormycosis. A comprehensive literature search was done in following databases, namely, PubMed, Google Scholar, Scopus, and EMBASE using keywords mucormycosis, rhino orbital cerebral mucormycosis, COVID-19, and SARS-CoV-2 (from November 01, 2019 to June 30, 2021). Our study shows that, while corticosteroids have proved to be lifesaving in severe to critical COVID-19 patients, its indiscriminate use has come with its price of rhino-orbito-cerebral mucormycosis epidemic, especially in India especially in patients with preexisting diabetes mellitus with higher mortality. Corticosteroid use should be monitored and all COVID-19 patients should be closely evaluated/monitored for sequelae of immunosuppression following treatment.
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Affiliation(s)
- Anusuya Bhattacharyya
- Department of Ophthalmology, Government Medical College and Hospital, Bathinda, Punjab, India
| | - Phulen Sarma
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | - Dibya Jyoti Sharma
- Department of Internal Medicine, Silchar Medical College and Hospital, Assam, India
| | - Karuna Kumar Das
- Department of Anaesthesia, Assam Medical College and Hospital, Assam, India
| | - Hardeep Kaur
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | | | - Subodh Kumar
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | - Seema Bansal
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | - Ajay Prakash
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | | | - Prasad Thota
- Scientific Officer, Department of Pharmacology, Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
| | | | | | - Bikash Medhi
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
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15
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Abstract
Mucormycosis is an emerging life-threatening fungal infection caused by Mucorales. This infection occurs mainly in immunocompromised patients, especially with hematological malignancy, transplantation, or diabetes mellitus. Rhino-orbito-cerebral and pulmonary mucormycosis are the predominant forms. Interestingly, location is associated with the underlying disease as pulmonary mucormycosis is more frequent in hematological malignancy patients whereas rhino-orbito-cerebral mucormycosis is associated with diabetes. Cutaneous mucormycosis results from direct inoculation, mainly after trauma or surgery. Gastro-intestinal mucormycosis occurs after ingestion of contaminated food or with contaminated device and involves the stomach or colon. Disseminated disease is the most severe form and is associated with profound immunosuppression. Uncommon presentations with endocarditis, osteoarticluar or isolated cerebral infections are also described. Finally, health-care associated mucormycosis is a matter of concern in premature newborns and burn units. Clinical symptoms and CT scan findings are not specific, only the early reversed halo sign is associated with pulmonary mucormycosis. Circulating Mucorales DNA detection is a recent promising diagnostic tool that may lead to improving the diagnosis and prompting therapeutic initiation that should include antifungal treatment, correction of the underlying disease and surgery when feasible.
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Affiliation(s)
- Alexandra Serris
- Université Paris Descartes, Centre d'Infectiologie Necker Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France.
| | - François Danion
- Université Paris Descartes, Centre d'Infectiologie Necker Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France.
| | - Fanny Lanternier
- Université Paris Descartes, Centre d'Infectiologie Necker Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France.
- Centre National de Référence mycoses invasives et antifongiques, Unité de Mycologie Moléculaire, Institut Pasteur, 75015 Paris, France.
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Wolkow N, Jakobiec FA, Stagner AM, Cunnane ME, Piantadosi AL, Basgoz N, Lefebvre D. Chronic orbital and calvarial fungal infection with Apophysomyces variabilis in an immunocompetent patient. Surv Ophthalmol 2017; 62:70-82. [PMID: 27256687 DOI: 10.1016/j.survophthal.2016.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 02/07/2023]
Abstract
Apophysomyces is a rare fungal organism causing rhino-orbito-cerebral mycotic infections with high morbidity and mortality, typically in immunocompetent individuals. Several cases of Apophysomyces elegans orbital disease have been reported. Herein, we report a case of Apophysomyces variabilis infection involving the orbit, sinuses, and calvarium in an immunocompetent 74-year-old woman, with a review of the literature. Unlike prior cases of A. elegans classic rhino-orbito-cerebral infection, our case included diffuse calvarial lytic lesions and overlying soft tissue nodules, but without parenchymal intracranial involvement. There was radiographic and clinical evidence of infarction of the orbital contents and cavernous sinus thrombosis. Anastomoses between the superior orbital (ophthalmic) vein and diploic veins of the calvarium are believed to be primarily responsible for the unusual mode of spread on the extradural surface of the brain. Although the patient stabilized without definitive surgical intervention, her disease slowly and intermittently progressed for over a year after presentation, requiring multiple courses of antifungal treatment.
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Affiliation(s)
- Natalie Wolkow
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Frederick A Jakobiec
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA.
| | - Anna M Stagner
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Mary E Cunnane
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne L Piantadosi
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nesli Basgoz
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Lefebvre
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Division of Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
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