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Article: Post Covid-19 Infection Presenting as Rhino-Orbital Mycosis.

Garg, Richa / Bharangar, Sandeep / Gupta, Sunil / Bhardwaj, Samiksha

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India

2021 Volume 74, Issue Suppl 2, Page(s) 3050–3057

Abstract: Rhino-orbital mycosis has been recently recognised as one of the sequelae in COVID-19 recovered ... that uncontrolled DM and prolonged use of corticosteroids may act as culprits of rhino-orbital mycosis in COVID-19 ... of COVID-19 infection. They presented with post covid fungal sinusitis and ophthalmic complications and ...

Abstract	Rhino-orbital mycosis has been recently recognised as one of the sequelae in COVID-19 recovered patients. In India, detection of mucormycosis is declared as notifiable disease. In this article, the authors aim to describe the characteristics of patients presenting with post covid fungal infection which could be detected on 10% potassium hydroxide (KOH) wet mount and Giemsa stain put on crush biopsy smear. We describe 10 COVID-19 recovered patients admitted to ENT department of the hospital during second wave of COVID-19 infection. They presented with post covid fungal sinusitis and ophthalmic complications and planned for surgery. KOH mount and Giemsa stain were used for possible opinion and confirmed by culture. The observations were described in mean and percentages. All ten (100%) COVID-19 recovered patients were previously diagnosed with type 2 diabetes mellitus (DM) for 2-11 years. All 10 patients (100%) were given oral or intravenous corticosteroids for mean of 21 days (3 weeks-till presentation to ENT department). Simple procedures with 10% KOH mount and Giemsa stain could detect fungal hypae in all the cases and could provide possible opinion in 9 of 10 (90%) cases for timely management of the patients. The authors hypothesize that uncontrolled DM and prolonged use of corticosteroids may act as culprits of rhino-orbital mycosis in COVID-19 recovered patients. Simple and routine 10% KOH mount and Giemsa stain may provide early opinion of fungal hypae to ensure quick management and survival of the patients.
Language	English
Publishing date	2021-07-14
Publishing country	India
Document type	Journal Article
ZDB-ID	1471137-0
ISSN	0973-7707 ; 2231-3796 ; 0019-5421
ISSN (online)	0973-7707
ISSN	2231-3796 ; 0019-5421
DOI	10.1007/s12070-021-02722-6
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Article: Mucormycosis in post-covid patients: An epidemic in pandemic.

Kesarwani, Vasudha / Kumar, Amit / Kesarwaani, Shivaam / Kesarwani, Divya

Journal of family medicine and primary care

2022 Volume 11, Issue 6, Page(s) 3368–3371

Abstract: Rhino-orbitol-cerebral mucormycosis (ROCM) is seen as a common post-coronavirus disease (COVID-19 ... is very high. We aimed to present six post-COVID mucor cases and to review the literature in terms ... the second wave of covid 19 pandemic. Clinical details for each case was obtained ...

Abstract	Rhino-orbitol-cerebral mucormycosis (ROCM) is seen as a common post-coronavirus disease (COVID-19) fungal infection in India. It is a lethal, opportunistic infection of the paranasal sinuses and brain caused by fungi of the Mucorales, most commonly with Rhizopus spp. Early diagnosis and timely management are essential. Other studies have shown high mortality up to 25-60%. However, in this study, the recovery rate is very high. We aimed to present six post-COVID mucor cases and to review the literature in terms of prevention, diagnosis, and management of this fatal infection. We carried out a retrospective case series of six patients with a confirmed diagnosis of ROCM presenting to a single tertiary-level hospital during the second wave of covid 19 pandemic. Clinical details for each case was obtained from the hospital information system. A total of six patients (five males and one female) were diagnosed with ROCM during this period. Out of six patients, four had diabetes mellitus and all were on steroid treatment during COVID-19 infection. The most common presenting features were headache (100%), facial pain (80%), orbital swelling (80%), and earache (20%). Most of the patients had sinusitis as a predominant finding in preop magnetic resonance imaging (MRI) at presentation. All patients received liposomal amphotericin B (LAmB) as the first line of treatment and subsequently shifted to posaconazole. The overall recovery rate was 100% and patients were discharged. ROCM infection is very hard to treat. The studies have shown cases with late presentation spreading beyond paranasal sinuses. Early intervention and treatment with antifungals and extensive surgical debridement resulted in the full recovery of all six cases.
Language	English
Publishing date	2022-06-30
Publishing country	India
Document type	Journal Article
ZDB-ID	2735275-4
ISSN	2278-7135 ; 2249-4863
ISSN (online)	2278-7135
ISSN	2249-4863
DOI	10.4103/jfmpc.jfmpc_1403_21
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Article: Risk factors for severe rhino-orbital mucormycosis during its epidemic post-COVID-19 pandemic.

Das, Gopal Krushna / Singh, Ankur / Beri, Nitika / Sahu, Pramod Kumar / Bisht, Tanya / Sharma, Isha

Indian journal of public health

2023 Volume 66, Issue 4, Page(s) 494–497

Abstract: Postsecond wave of COVID-19 pandemic in the year 2021, rhino-orbital mucormycosis (ROM) was seen ... common presenting complaint. Subclinical and mild COVID-19 infection was associated with severe ROM ...

Abstract	Postsecond wave of COVID-19 pandemic in the year 2021, rhino-orbital mucormycosis (ROM) was seen as an epidemic in the Indian community. Severe ROM disease has poor prognosis and requires a multidisciplinary approach for treatment. Hence, its prevention is better than cure. Studies done during the epidemic assessed predisposing factors, but this was a novel study which focused on assessing risk factors for severe disease of ROM. Ninety-four consecutive patients of ROM admitted at our designated nodal tertiary hospital of North India were enrolled, and data were collected and analyzed. Facial edema was the most common presenting complaint. Subclinical and mild COVID-19 infection was associated with severe ROM. Uncontrolled diabetes mellitus and prophylactic zinc supplementation were other significant risk factors for severe ROM. Public awareness among the general population for the above risk factors can prevent a debilitating disease like severe ROM.
MeSH term(s)	Humans ; COVID-19 ; Mucormycosis/epidemiology ; Pandemics ; India/epidemiology ; Risk Factors
Language	English
Publishing date	2023-01-10
Publishing country	India
Document type	Journal Article
ZDB-ID	800737-8
ISSN	2229-7693 ; 0019-557X
ISSN (online)	2229-7693
ISSN	0019-557X
DOI	10.4103/ijph.ijph_714_22
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Article ; Online: Invasive Mucormycosis and Aspergillosis Coinfection Associated with Post-COVID-19 Pneumonia in a Tertiary Care Hospital.

Paul, Mousumi / Sasidharan, Jaseetha / Taneja, Juhi / Chatterjee, Kuhu / Abbas, S Zafar / Chowdhury, Veena / Das, Asim

Medical mycology journal

2022 Volume 63, Issue 3, Page(s) 59–64

Abstract: ... after digestion and clearing of the tissue. A high index of suspicion of mixed infection post-COVID-19 ... retrospective analysis of 12 patients with confirmed diagnosis of mixed invasive fungal infections post-COVID-19 ... disease out of 70 cases of COVID-19-associated mucormycosis (CAM) presenting to a tertiary-level hospital ...

Abstract	Acute invasive fungal rhinosinusitis is a rare infection primarily affecting patients with co-morbidities like immunosuppression and poorly controlled diabetes. Mucormycosis is increasingly being reported in patients with SARS-CoV-2 (COVID-19). However, reports of coinfection of aspergillosis and mucormycosis involving nose, paranasal sinuses, orbit, and brain are rare in literature. We aimed to evaluate the patient demographics, clinical presentation, and management of cases presenting with mixed infection. We carried out retrospective analysis of 12 patients with confirmed diagnosis of mixed invasive fungal infections post-COVID-19 disease out of 70 cases of COVID-19-associated mucormycosis (CAM) presenting to a tertiary-level hospital in North India from May to June 2021. All patients had diabetes mellitus; the mean age was 48 years. The common presenting features were headache, nasal congestion, palatal ulcer, and vision loss accompanied by facial pain and swelling. Two patients developed cerebral abscess during the course of treatment; three patients had concurrent COVID-19 pneumonia. All patients received systemic liposomal amphotericin B and serial surgical debridements. The overall mortality rate was 16.7%. Our study demonstrates that mucormycosis and aspergillosis are angioinvasive mycoses that are clinically and radiologically identical. KOH direct mount of clinical sample showing septate hyphae should be extensively searched for aseptate hyphae after digestion and clearing of the tissue. A high index of suspicion of mixed infection post-COVID-19 and early initiation of liposomal amphotericin B followed by prompt surgical intervention can reduce the overall morbidity and mortality among patients with this condition.
MeSH term(s)	Antifungal Agents/therapeutic use ; Aspergillosis/microbiology ; COVID-19/complications ; Coinfection/complications ; Coinfection/drug therapy ; Coinfection/microbiology ; Humans ; Invasive Fungal Infections/drug therapy ; Middle Aged ; Mucormycosis/complications ; Mucormycosis/diagnosis ; Retrospective Studies ; SARS-CoV-2 ; Sinusitis/complications ; Sinusitis/microbiology ; Tertiary Care Centers
Chemical Substances	Antifungal Agents
Language	English
Publishing date	2022-09-02
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2628906-4
ISSN	1882-0476 ; 2186-165X ; 2185-6486 ; 0916-4804
ISSN (online)	1882-0476 ; 2186-165X
ISSN	2185-6486 ; 0916-4804
DOI	10.3314/mmj.21-00019
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Article ; Online: Post-COVID-19 rhino-orbito-cerebral mucormycosis: a new addition to challenges in pandemic control.

Mitra, Sandipta / Janweja, Mridul / Sengupta, Arunabha

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

2021 Volume 279, Issue 5, Page(s) 2417–2422

Abstract: ... interventions for early clinical detection and management of post-COVID-19 rhino-orbito-cerebral mucormycosis (ROCM ... since onset of COVID-19 symptoms was 18 (± 4) days. 12.5% patients were fully vaccinated. 78.1% patients ... involvement, 43.75% orbit sparing orbital apex, 68.75% orbit with orbital apex. 81.25% patients had ...

Abstract	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.
MeSH term(s)	Adult ; Aged ; Antifungal Agents/therapeutic use ; COVID-19 ; Eye Infections, Fungal/drug therapy ; Eye Infections, Fungal/epidemiology ; Eye Infections, Fungal/microbiology ; Humans ; Middle Aged ; Mucormycosis/diagnosis ; Mucormycosis/epidemiology ; Mucormycosis/therapy ; Orbital Diseases/diagnosis ; Orbital Diseases/therapy ; Pandemics ; SARS-CoV-2
Chemical Substances	Antifungal Agents
Language	English
Publishing date	2021-07-26
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1017359-6
ISSN	1434-4726 ; 0937-4477
ISSN (online)	1434-4726
ISSN	0937-4477
DOI	10.1007/s00405-021-07010-1
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Article ; Online: Crush cytology smears – A novel approach to rapid diagnosis of rhino-orbital mucormycosis in post-COVID-19 patients

Amruta Patil / Sagar More / Archana Patankar / Arpana Shinde

Asian Journal of Medical Sciences, Vol 13, Iss 6, Pp 12-

A single-center study

2022 Volume 17

Abstract: ... from all the clinically suspected cases of mucormycosis with a history or associated present COVID-19 infection ... Background: With recent surge in SARS-COVID-19, cases of rhinocerebral mucormycosis are on rise ... of 43 patients, 41 recovered from COVID-19 disease with mean duration of 12 days. Hospital stays ...

Abstract	Background: With recent surge in SARS-COVID-19, cases of rhinocerebral mucormycosis are on rise. Rapid diagnosis of mucormycosis is essential as delay in the treatment is associated with dreadful outcome. Many studies have found that crush cytology smears can rapidly diagnose mucormycosis as compared to histopathology, thereby reducing the time for arriving at final diagnosis, here, we present a novel approach to the rapid diagnosis of mucormycosis by crush cytology and analyze whether it has a higher sensitivity in diagnosing cases of mucormycosis. Aims and Objectives: This study aims to analyze the efficacy of crush cytology smear in rapid diagnosis of mucormycosis. Materials and Methods: Biopsies received from all the clinically suspected cases of mucormycosis with a history or associated present COVID-19 infection. The biopsy was processed for KOH preparation, crush cytology smear and confirmation were done by histopathological examination. Special stains were done wherever necessary. Results: Out of 50 cases of clinically suspected mucormycosis, 43 confirmed on histopathology. Out of 43 confirmed cases of mucormycosis, 33 (76.74 %) were male and 10 (23.25%) were female with male: female ratio of 3.3:1. The mean age of the studied cases was found to be 52.32±12.59 years. The most common presenting complaint was fever (79.07%), followed by headache/retro-orbital pain (62.79%), rhinorrhea (58.14%), and facial swelling (53.49%). Out of 43 patients, 41 recovered from COVID-19 disease with mean duration of 12 days. Hospital stays of patients with for COVID-19 varied from 7 days to maximum of 35 days. Out of 43 cases of mucormycosis, 24 cases were diagnosed with KOH mount with sensitivity of 55.81% and 39 cases with crush cytology smears with sensitivity of 90.69%. Conclusion: The diagnosis of mucormycosis is done with the gold standard methods such as histopathological examination and culture studies but the present study emphasizes on use of crush cytological smears prepared from sinonasal biopsies in suspected ...
Keywords	mucormycosis ; covid-19 ; cytology ; early diagnosis ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	Manipal College of Medical Sciences, Pokhara
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Spectrum of magnetic resonance imaging findings in post-COVID-19 patients presenting with rhino-orbito-cerebral mucormycosis in a teaching hospital in Malwa region of Punjab

Pushpinder Singh / Kiranjeet Kaur / Vinita Jindal / Manjot Kaur / Mandeep Kaur / Navdeep Singh

Journal of Family Medicine and Primary Care, Vol 11, Iss 12, Pp 7788-

2022 Volume 7794

Abstract: ... patients (28.33%). Conclusion: In post-COVID-19 patients presenting with clinical features suspected ... Background: Rhino-orbito-cerebral-mucormycosis (ROCM) associated with COVID-19 infection was ... Results: On the basis of the spectrum of MRI findings, post-COVID-19 related ROCM was broadly categorized ...

Abstract	Background: Rhino-orbito-cerebral-mucormycosis (ROCM) associated with COVID-19 infection was at its peak during and immediately after the second wave of the pandemic in India during 2021. Many of the risk factors were implicated in the development of this deadly fungal infection, when there was a sudden surge of cases, especially who had a history of COVID-19 infection. Objectives: The objective of the study was to describe the characteristic magnetic resonance imaging (MRI) findings in invasive mucormycosis and to evaluate the extent and severity of invasive mucormycosis. Materials and Methods: A retrospective study was carried out for 4 months which included 60 patients who underwent MRI using a Siemens Avanto 1.5 Tesla scanner. During our study, 68 cases were selected based on clinicoradiological features suspected of ROCM. However, 8 patients were excluded on the basis of exclusion criteria as either there was no definitive evidence of COVID infection or were proven to be negative for mucormycosis on microbiological examination. Results: On the basis of the spectrum of MRI findings, post-COVID-19 related ROCM was broadly categorized into three stages. Out of total of 60 patients, the disease was localized to the nasal and paranasal sinus region (Stage I) in 7 patients (11.66%), extending to adjacent extrasinus orofacial soft tissue structures (Stage II) in 36 patients (60%), and intracranial extension of disease (Stage III) was seen in 17 patients (28.33%). Conclusion: In post-COVID-19 patients presenting with clinical features suspected of ROCM, MRI imaging helps in early diagnosis and staging/severity of ROCM, so that timely intervention can be planned to reduce mortality as well as morbidity.
Keywords	black turbinate sign ; covid-19 ; mucormycosis ; orbital cellulitis ; rocm ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Post Covid-19 Infection Presenting as Rhino-Orbital Mycosis.

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Article: Mucormycosis in post-covid patients: An epidemic in pandemic.

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Article: Risk factors for severe rhino-orbital mucormycosis during its epidemic post-COVID-19 pandemic.

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Article ; Online: Invasive Mucormycosis and Aspergillosis Coinfection Associated with Post-COVID-19 Pneumonia in a Tertiary Care Hospital.

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

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Article ; Online: Crush cytology smears – A novel approach to rapid diagnosis of rhino-orbital mucormycosis in post-COVID-19 patients

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Article ; Online: Spectrum of magnetic resonance imaging findings in post-COVID-19 patients presenting with rhino-orbito-cerebral mucormycosis in a teaching hospital in Malwa region of Punjab

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