Abstract
The COVID-19 pandemic has led to a dramatic rise in the incidence of rhino-orbito-cerebral mucormycosis (ROCM) in India. The purpose of our report is to describe the prevalence of ROCM in the context of SARS-CoV-2 infection during the second Indian COVID-19 wave, as well as its diagnostics proceeding, and to discuss the challenges met in the time frame from the suspected diagnosis to the therapeutic decision in such patients. We conducted a retrospective multicentre case series study at six centres of Sudhalkar and Raghudeep group of hospitals in India. ROCM was confirmed in 38 (2.5%) of the 1546 patients admitted with SARS-CoV-2 infection. The average time to establish a diagnosis was 16 days. In total, 19 (50%) patients suffered from type 2 diabetes and were mostly treated with hypoglycaemic agents (in 90% of cases). The standard of care for SARS-CoV-2 management included systemic steroids therapy, intravenous remdesivir for 5 days, and concomitant prophylactic antibiotic therapy following admission. The median (IQR) blood glucose levels in all patients during the course of hospitalisation was 320 (250.5–375) mg/dl. A total of 16% of patients had an irreparable functional loss, and the mortality was 5%. We may hypothesise that excessive administration of antibiotics that profoundly affects human microbiota, coupled with poorly controlled glycaemia and unprotocolised haphazard steroid administration, contribute to a favourable setting for mucormycosis infections.
Highlights
Rhino-orbital-cerebral mucormycosis (ROCM) is a rare invasive fungal infection of the nasal and maxillary sinuses and the orbit
We report here a case series of ROCM, managed by ophthalmologists, in six referring centres of Sudhalkar and Raghudeep group of hospitals in India
The purpose of our report is to describe the prevalence of ROCM in the context of SARS-CoV-2 infection during the second Indian COVID-19 wave, as well as its diagnostics proceeding, and to discuss the challenges met in the period from the suspected diagnosis to the therapeutic decision in such patients
Summary
Rhino-orbital-cerebral mucormycosis (ROCM) is a rare invasive fungal infection of the nasal and maxillary sinuses and the orbit. The causing agent, Mucorales, from the family of mucormycetes fungi, includes more than 300 species and may be responsible for opportunistic infections, especially in immunosuppressed patients [1]. Particular attention to the ROCM was brought about following the first and second epidemic COVID-19 waves in India and other countries [2,3], where mucormycosis was mediatised by several world-renowned media [4]. Acute SARS-CoV-2 infection, as well as the non-specific treatment (including steroids and monoclonal antibodies immune therapy), exposes COVID-19 patients to the risk of opportunistic infections, including mucormycosis. Several predisposing risk factors for the development of ROCM were identified retrospectively. These include uncontrolled diabetes, immunosuppression, hemochromatosis, ketoacidosis, and damage to the physical barriers of the immune system [5]
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