COVID-19-ассоциированный риноорбитальный мукормикоз

Abstract

Relevance. Mucormycosis is a rare aggressive fungal infection that often affects people with weakened immune systems, in particular those suffering from diabetes mellitus. Since the emergence of the SARS-CoV-2 virus, a significant increase in cases of mucormycosis has been reported, especially in some hot countries, in particular India, as a rule, after suffering a new coronavirus infection COVID-19. Rhino-orbital mucormycosis (ROM), as a manifestation of the rhino-cerebral form of the disease, can initially be localized in the nose and paranasal sinuses, then quickly spread to the orbit and the cranial cavity. Purpose. To present case reports with covid-associated rhino-orbital mucormycosis. Material and methods. The study included 29 patients admitted to the hospital with ROM, which developed 20-40 days after a new coronavirus infection COVID-19. All patients underwent eye examination, which included visometry, biomicroscopy, ophthalmoscopy, pneumotonometry, and in some cases exophthalmometry. In addition, all patients underwent computer or magnetic resonance imaging of the brain, orbit and paranasal sinuses. Results. All the patients had a medical history of long-term antibacterial and steroid therapies. It should be noted that due to the pandemic, steroid and antibiotic therapies in 25 patients (86.2 %) was uncontrolled, since in most cases it was carried out on an outpatient basis. All the patients upon admission suffered from type 2 diabetes mellitus. Ocular and orbital signs of ROM were detected in all 29 patients which were manisfested by the following symptoms: fever, sinus pain, orbital cellulitis, with exophthalmos, permanent loss of vision, black necrosis of the palate, nasal sinuses, nasal septum. The mortality rate was 44.8 % (13 patients). Conclusion. Diabetes mellitus is one of the most important risk factors for the development of such a formidable fungal infection as mucormycosis, which developes in patients after moderate or severe COVID-19, as well as long-term and uncontrolled outpatient high doses of antibiotics and especially corticosteroids. In addition to intensive antifungal therapy, surgical treatment is indicated to all the patients with rhino-orbital mucormycosis, due to the high risk of fungal infection entering the cranial cavity and, therefore, the lethality of the disease. Keywords: COVID-19, rhinocerebral and rhinocerebral covid-associated mucormycosis, treatment with large doses of steroids and antibiotics, diabetes mellitus, clinical cases