Post-COVID-19 rhino-orbito-cerebral mucormycosis: a new addition to challenges in pandemic control

• Published in: European archives of oto-rhino-laryngology Vol. 279; no. 5; pp. 2417 - 2422
• Main Authors: Mitra, Sandipta, Janweja, Mridul, Sengupta, Arunabha
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2022
• Subjects: Adult; Aged; Antifungal Agents - therapeutic use; COVID-19; Eye Infections, Fungal - drug therapy; Eye Infections, Fungal - epidemiology; Eye Infections, Fungal - microbiology; Head and Neck Surgery; Humans; Medicine; Medicine & Public Health; Middle Aged; Mucormycosis - diagnosis; Mucormycosis - epidemiology; Mucormycosis - therapy; Neurosurgery; Orbital Diseases - diagnosis; Orbital Diseases - therapy; Otorhinolaryngology; Pandemics; Rhinology; SARS-CoV-2; COVID-19; Mucormycosis; SARS-CoV-2; Paranasal sinuses
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-021-07010-1

Objective To document and analyse demographic data, clinical presentation, possible interventions for early clinical detection and management of post-COVID-19 rhino-orbito-cerebral mucormycosis (ROCM). Method 32 patients having history of SARS-CoV-2 infection with features of ROCM were observed in terms of their history, presenting features, clinical, microbiological examination, type of surgical intervention, surgical sites of involvement which were subsequently analyzed. Results The mean (± S.D.) age of patients was 57 ± 13 years. All patients were diabetic. Mean (± S.D.) time of onset of ROCM symptoms, since onset of COVID-19 symptoms was 18 (± 4) days. 12.5% patients were fully vaccinated. 78.1% patients received steroid therapy; 28.1% received high flow nasal oxygen. 87.5% patients had blurring of vision, 65.62% headache, 59.37% cheek and eyelid swelling, 50% proptosis, 46.87% ophthalmoplegia, 40.62% ptosis, 40.62% loss of sensation over cheek, 25% orbital pain. Examination of specimen with KOH mount revealed Mucor spp. in all patients. 87.5% patients underwent endoscopic sinus surgery with debridement with/without orbital clearance; 56.25% maxillectomy; 25% orbital exenteration. 87.5% patients had paranasal sinus involvement, 43.75% orbit sparing orbital apex, 68.75% orbit with orbital apex. 81.25% patients had involvement of pterygopalatine fossa±infratemporal fossa. 50% patients had disease in Vidian canal and pterygoid wedge. 25% of patients had involvement of palate and 56.25% cheek and eyelid soft tissues. Conclusion A judicious COVID treatment protocol, high index of suspicion, close monitoring of high-risk patients and early institution of treatment can prevent case severity and reduce mortality.