Cerebral Mucormycosis Research Articles

Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India.

Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors. An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1year from discharge was done. 367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3years (SD 12.4years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics. Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.

Mucormycosis in Human Immunodeficiency Virus-Infected Individuals: A Systematic Review of Case Reports.

Mucormycosis in human immunodeficiency virus (HIV) infection is uncommon; notably, many cases have additional predisposing factors. Whether mucormycosis differs in HIV-affected individuals with and without additional risk factors (e.g., neutropenia, diabetes mellitus, and transplantation) remains unclear. In this systematic review, we identified 94 cases of HIV and mucormycosis classifiable into three groups: (1) HIV with additional risk factors (n = 50), (2) intravenous drug users (IVDU, n = 24), and (3) no other risk factor (n = 19) for mucormycosis. The most common presentation in IVDU was renal (41.7%) and cerebral mucormycosis (39.2%), whereas rhino-orbital mucormycosis (ROM, 4.2%) was uncommon. In the other two groups, ROM was the most common presentation. Rhizopus was the most frequently isolated Mucorales; however, in IVDU, Lichtheimia was the most common. The overall mortality was 53% and not significantly different in the three groups. Mucormycosis in HIV-infected individuals is rare without additional risk factors or IVDU.

Role of histopathology in severity assessments of post-COVID-19 rhino-orbital cerebral mucormycosis - A case-control study

BackgroundThere was an upsurge in rhino-orbital-cerebral mucormycosis (ROCM) during the second wave of the COVID-19 pandemic in India. Histopathological examination of the biopsies witnessed greater tissue invasion in these cases. The present study aimed to evaluate the histopathological scoring system in the severity assessment and to compare the scores between ROCM that required orbital exenteration (cases) and those that were treated conservatively (controls). Material and methodsA retrospective study was conducted to analyze the histopathological features using a scoring system in patients diagnosed with mucormycosis on sino nasal biopsies. The scoring was based on the following parameters: the extent of necrosis (score 1 <50% and score 2 >50%), degree of angioinvasion (score 1 <3 vessels in 10 fields and score 2 > 3 vessels in 10 fields), degree of inflammation (mild, moderate or severe), and fungal load(score 1 to 4), based on which three grades (I to III) were given. The scores were compared between the case group and the control group. The data obtained were analyzed statistically. ResultsThe study included 40 controls and 10 cases. The median age of patients in the control group was 52 with 82.5%males (n = 43) and 17.5 % females (n = 7) while in the case group, the median age was 51 years, and all were males. The predominant inflammatory response was of mixed suppurative type (70 %, n = 28). The degree of necrosis was scored 2 in 57.5 % (n = 23) of controls and 70 %(n = 7) in the case group. All the samples in the case group showed scores of 2 for angioinvasion and scores of 3 and 4 for fungal load. There was a statistically significant difference in the degree of necrosis, angioinvasion, the severity of neutrophilic infiltrates, and fungal load between the cases and controls (p-value <0.05). ConclusionThe present study analyses the predictive role of histopathology in invasive mucormycosis. Higher fungal load, degree of angioinvasion, and the absence of granulomas are associated with advanced disease in sinonasal mucormycosis. The study findings recommend incorporating the histopathological scoring criteria in evaluating patients with sinonasal mucormycosis.

Turbinates involvment in rhino orbital cerebral mucormycosis in covid positive cases - A study on 100 cases

Mucormycosis also called as zygomycosis previously refers to several different diseases caused by infection with fungi belonging to the order Mucorales. Rizopus species are the most common causative organism. The infections are life threatening. Risk factors such as Diabetic Ketoacidosis and Neutropenia are present in most cases. During the pandemic period of COVID-19 2 wave rhino orbital mucormycosis was commonly effected with probable reasons are due to over dosage of steroid usage and o2 therapy, Uncontroled diabetes etc. To know the percentage of involvement of turbinates (MT,IT)in Rhino orbito cerebral mucormycosis cases in covid positive patients by doing endoscopic sinus surgery. A total of 100 covid positive patients with ROMM were selected and taken for radiological evaluation and selected for ESS during intraoperatively turbinates involvement with mucor (eschar/pus/crusting) was noted diagnosis of ROMM was based on CECT findings and symptoms in covid positive cases. Patients who are attending to Gandhi hospital during the pandemic of 2 wave of covid 19 were selected in study. Common age group with ROMM are 36to 55 years, with male predominance, commonest symptoms are unilateral facial pain &amp; swelling, nasal crusting and dental complaints, commonest sinus to be involved is maxillary sinus, comorbid condition is Diabetes mellitus and moderate percentage of involvement of turbinates(common is middle turbinate) were noted. On microbiological and pathological examination of specimen showed positive KOH mount and mucorales order fungi are common followed by rizopus species. Main conclusions in this study are turbinates involvement with mucor in covid positive cases (eschar/necrosis/pus discharge) is more common in 43 patients (43%), most common mucor pathology seen in maxillary sinus in 58 patients(58%),followed by ethmoid sinus and sphenoid and orbit, teeth.

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.

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.

Clinical profile of COVID-19-associated mucormycosis patients and the clinical suspects: a descriptive audit

BackgroundIndia witnessed a massive surge of rhino orbital cerebral mucormycosis (ROCM) cases during the second wave of COVID-19, recording the highest number of cases in the world, indeed, an epidemic within the pandemic.ObjectivesTo describe the clinical profile of patients with COVID-19-associated mucormycosis (CAM) and the clinical suspects for mucormycosis.MethodsThis single-center descriptive, observational study/audit was done at Indira Gandhi Medical College, Pondicherry, South India. This study is about the clinical profile of 7 CAM patients and 14 COVID-19 patients who were suspects of CAM, based on their risk factors and clinical symptoms, and were referred to the ENT department.Statistical analysisAll the descriptive variables were summarized as mean, frequency, and percentages for qualitative data.ResultsAll 7 CAM patients were COVID-19 positive and were not vaccinated against COVID-19, All 7 were known diabetic, all 7 had steroid therapy for their COVID status, and 5 out of 7 (71%) had uncontrolled diabetes mellitus at the time of diagnosis. Facial pain, nasal discharge, and eye swelling were the presenting symptoms of CAM. Maxillary and ethmoid sinuses were the most commonly involved para nasal sinuses. Four out of seven (57.1%) CAM patients survived after 16 months of follow-up, after surgical and medical treatment for CAM. Of the 14 clinical suspects who were negative for CAM, 2 were negative for COVID-19, their risk factors were brought under control, 3 expired due to COVID complications, and 9 patients are alive till date.ConclusionUncontrolled diabetes is a risk factor for ROCM/CAM, another possible risk factor is steroid therapy, and we hypothesize that COVID infection could also be a possible risk factor that needs to be studied more extensively in a larger sample. Early clinical suspicion, withdrawal of steroids, rapid control of diabetes mellitus, appropriate investigations, and early surgical intervention combined with medical treatment offers better outcome.

COVID-19 and Mucormycosis of Orofacial Region: A Scoping Review.

During the second wave of coronavirus disease, orCOVID-19, infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in the year 2021 around the globe, there is a surge in the number of cases of mucormycosis or "Black Fungus" that is directly/indirectly associated with COVID-19. In this review article, mucormycosis of the orofacial region has gained importance from the maximum published literature (45 articles) from various databases like PubMed, Google Scholar, Scopus, Web of Science, and Embase. Rhino-orbital cerebral mucormycosis (ROCM) is a fatal condition associated with COVID-19 among categories of mucormycosis such as pulmonary, oral, gastrointestinal, cutaneous, and disseminated. ROCM targets the maxillary sinus, also involving teeth of the maxilla, orbits, and ethmoidal sinus. These are of particular interest to dentists and oral pathologists for proper diagnosis and identification. Co-morbid conditions, especially diabetes mellitus type II, have to be monitored carefully in COVID-19 patients as they have a higher risk of developing mucormycosis. In this review article, various presentations of COVID-19-linked mucormycosis are mentioned having particular emphasis on pathogenesis, signs and symptoms, clinical presentation, various diagnostic modalities including histopathology, radiology like CT and MRI, serology, tissue culture, various laboratory investigations, treatment protocols, management with prognosis, and so on. Any suspected case of mucormycosis needs quick detection and treatment since it progresses quickly due to the destructive course of infection. Long-term follow-up along with proper care is a must to detect any kind of recurrence.

A case of rhino-orbital cerebral mucormycosis presenting with spontaneous cerebrospinal fluid rhinorrhoea

Rhino orbital cerebral mucormycosis has increased in the recent second wave of post COVID 19 illness, mainly in tropical countries like India.

Comparative Study of Clinical Severity and Biochemical Markers in Pre COVID-19 and COVID-19 Rhino-Orbito Cerebral Mucormycosis

In view of high surge of sinonasal mucormycosis cases after the second wave of covid 19, present study was planned to know and compare the clinical severity of the disease and also to better understand the difference in the biochemical markers during precovid and post covid period. This retrospective observational study included all cases of sinonasal mucormycosis which were treated in our institute from August 2012 to August 2021. Details of these cases were collected from hospital database system. Biochemical parameters included FBS, HbA1C, urine ketone bodies, blood pH and creatinine. Clinical severity score was measured using self-structured severity scoring system. We found that out of 74 cases treated in our hospital 28 cases were in pre covid period while 46 cases belonged to covid 19 period. Higher male predominance was seen during post covid period (76% vs. 60%). Urine ketone bodies were positive in 7% patients in precovid period compared to 26% in post-covid period. FBS and HbA1C were high approximately 80 and 90% patients respectively in both groups. Clinical severity was significantly high in post covid patients. The present study showed that in spite of similar biochemical profile. The severity of mucormycosis was high in covid positive patients. This study shows that Covid-19 is an independent high risk factor in mucormycosis patients.

A RETROSPECTIVE ANALYSIS OF HISTOPATHOLOGICAL FINDINGS IN RHINOORBITAL FUNGAL INFECTION IN POST COVID 19 PATIENTS

Introduction: Health care sector across India reported signicant increase in cases of covid linked mucormycosis and other fungal infections in covid 2nd wave. Mucormycosis is an opportunistic fulminant fungal infection in immunocompromised host. Concomitant diabetes and use of high dose steroid, further add to already compromised immunity in covid patients. It may manifest as rhino-orbital or cerebral mucormycosis. Fungus invades the arterioles and causes tissue necrosis, which is the hallmark of mucormycosis. Objectives: To study frequency and histomorphology of various tissue invasive fungal infections and their corelation with other parameters. Material and Methods: This is retrospective observational study. Here we present histological and other ndings in 236 cases of clinically suspected post covid fungal infection during 2-month periods. Out of 236 specimens received Result: , 211 showed presence of tissue invasive fungal infection with positivity rate of 89.4%, where male to female ratio was 2.2:1, mean age was 51 years. Most common organism detected was mucor species in 72%, Aspergillus in 4.3% and 23.7% had mixed infection. Angioinvasion was seen in 38.86%. The most common site of involvement was sinonasal (84.36%) followed by orbital (15.16%) and cerebral (0.47%). 68.18% patients were diabetics, 39% had history of moderate to severe covid requiring oxygen, 72.7% had received steroid. Conclusion: Diabetes mellitus and rampant use of corticosteroid in a background of Covid-19 appears to increase opportunistic fungal infection. Mucor and aspergillus were commonly observed tissue invasive and angioinvasive fungal species.

Anaesthetic challenges of coronavirus disease (COVID-19) associated mucormycosis: A case series

During the second wave of COVID -19 Indian subcontinent suffered another pandemic of covid associated mucormycosis (CAM) which further burderned the already overexhausted health care infrastructure. To share our experience of anaesthetic management of eighteen patients with covid associated mucormycosis who underwent surgical resection of necrotized tissues at a tertiary care hospital of North India. : Eighteen patients with COVID-19 infection or previous history of COVID-19 infection based on RT-PCR and histopathologically proven rhino orbital mucormycosis, presented for endoscopic and open surgeries during May and June 2021. According to institutional protocol, institutional ethical committee clearance was not required for a case series. Data regarding the demographic details, clinical manifestations, COVID-19 course, laboratory parameters, imaging reports, pre-operative evaluation, airway management, intraoperative and postoperative management, and complications were collected. Out of eighteen patients 12(66.7%) were male and six (33.33%) were female, with a median age of 51 years. Six patients (33.33%) had a past history of COVID-19, twelve patients had concurrent COVID-19 (66.66%). Most of the patients presented with unilateral facial swelling, retro-orbital pain, ptosis and headache. Fifteen (83.33%) patients had high blood sugars, seven (46.66%) were known type 2 diabetics and eight (53.33%) developed new-onset diabetes after taking prolong systemic corticosteroids. All eighteen patients received antifungal treatment,eight (44.44%)patients had derranged renal function tests with raised serum creatininine (2.4-2.8) and normal blood urea nitrogen. Eight (44.44%) of them had difficult airway because of swelling on face and limited mouth opening, two patients were reoperated (n=2/18). Three (27.27%) patients deveoped arrythmias and ST changes intraoperatively, two(n=2/18) patients were extubated next day after surgery, one patient was tracheostomised in view of preoperative difficult airway and extensive surgery. One fiftyfive year old covid positive female patient died on fifth postoperative day. : In our case series, all 18 patients had covid associated rhino-orbital mucormycosis, most of them had diabetes and hypertension, cerebrovascular accident, coronary artery disease, asthma and post KTP status. Twelve patients were covid positive and 6 had recent history of covid. One patient developed hemiparesis and one patient died because of intracranial extension of mucormycosis. Disseminated or cerebral mucormycosis, severe covid, elderly age group, associated comorbidities like uncontrolled diabetes and renal failure have been found to increases mortality in CAM patients. : Physicians caring for covid associated mucormycosis patients must be aware of the severity of the covid-19 as well as mucormycosis, associated comorbidities and various side effects of the medications used for treatment. Early diagnosis and timely medical and surgical management are necessary to improve outcome in covid associated mucormycosis.

Rhino-Orbital Cerebral Mucormycosis in a Diabetic Patient: An Emergency Medicine Case Report

BackgroundRhino-orbital cerebral mucormycosis (ROCM) is a rare infection caused by an invasive fungus and found predominantly in immunocompromised patients. The presentation of ROCM ranges from a mild headache, fever, and sinusitis to vision loss, altered mental status, and facial disfigurement secondary to local tissue invasion. ROCM can cause significant morbidity and mortality and requires prompt diagnosis with timely evaluation by surgical and infectious disease specialists. Cases of ROCM have been reported extensively in internal medicine, infectious disease, and otolaryngology literature. However, there are very few reports in emergency medicine literature in the United States. Case ReportA 72-year-old woman presented to the Emergency Department (ED) with altered mental status, 4 days of left-sided facial numbness and weakness, and sudden facial pain, swelling, and erythema. Laboratory analysis was consistent with diabetic ketoacidosis. Noncontrast computed tomography of the head and magnetic resonance imaging of the brain demonstrated findings indicative of invasive fungal infection of the left sinus and orbit with extension to the cavernous sinus and surrounding cranial nerves. She was initiated on broad-spectrum antifungals, but based on the extent of the infection, was not a surgical candidate. She subsequently transitioned to a comfort-based plan of care and died 6 days after initial ED presentation. Why Should an Emergency Physician Be Aware of This?Early recognition and initiation of treatment can potentially mitigate the devastating outcomes of ROCM, therefore it is critical to be aware of this condition and have a high level of suspicion in susceptible patients.

MANAGEMENT AND FUNCTIONAL OUTCOME OF SARS COVID-19 INDUCED RHINO ORBITAL CEREBRAL MUCORMYCOSIS

Background: Rhino-orbital cerebral mucormycosis(ROCM) is an uncommon infection caused by the angiotropic fungus belonging to the order Mucorales and has high morbidity and mortality despite treatment. Rhino-orbital cerebral mucormycosis almost always occurs in immunocompromised hosts, including patients with uncontrolled diabetes mellitus, hematologic cancers, and solid organ or hematopoietic stem cell transplants. The suspicion or diagnosis of rhino-orbital cerebral mucormycosis triggers a medical as well as surgical emergency with the delay in treatment, increasing morbidity and mortality. Aim: 1.outcome of medical management 2.functional outcome and evaluation after medical management 3.complications of mucormycosis 4.outcome after surgical management Methods: 62 SARS covid-19 cases were evaluated who were diagnosed with rhino orbital cerebral mucormycosis.most of the patients presented with ptosis.proptosis.orbital cellulitis,decreased visual acuity,sluggishly reacting pupils, restricted extraocularmovemets.some patients were known diabetics and some diagnosed with diabetes after COVID 19 reovery.Retrobulbar Liposomal Amphotercin –B(3.5mg) was given to all patients for 10 alternate days and simultaneously patients received IV LIPOSOMAL AMPHOTERCIN 300mg OD for 10days renal function tests were monitored. 54 of them improved on day 5 of injection most patient Results: s visual acuity improved from CF –CF to CF&gt;6mts, patients with perception of light didn't show any improvement in visual acuity but ptosis,proptosis,conjunctival congestion and chemosis was improved and 10 patients underwent exenteration. ROCM is seen Conclusion: in most SARS COVID 19 who were known diabetics or post covid -19 induced uncontrolled high sugars most patients received high dose of steroids during covid 19 treatment.most patient showed improvement of symptoms after retrobulbar IV Amphotericin 3.5mg and improvement is observed on MRI stages too and some patients underwent exenteration which prevented furthurer spread of infection

Mucormycosis and COVID 19: Demography, associated co-morbidities and laboratory diagnosis in a Tertiary Care Hospital

Purpose: The pathogenesis and treatment of severe COVID-19 infection in a patient makes him susceptible to many co-infections/super-infections, out of which the highest surge was of Post COVID mucormycosis. Prevention, early detection and management of Post COVID mucormycosis is essential due to its devastating and fatal outcome. The present study was performed to describe the clinico-demographic risk factors and role of various diagnostic modalities available for diagnosing mucormycosis in COVID-19 patients admitted in a super-speciality hospital. Method: A retrospective observational study was performed on 15 patients admitted with a clinical diagnosis of mucormycosis associated with COVID-19 infections, in a tertiary care centre between May 2021 to July 2021.Demographic details such as age, gender, Diabetes mellitus(DM), hypertension, glycosylated haemoglobin status ,existing immunocompromised conditions, other co-morbidities, time duration for reporting diseases after COVID-19 treatment, use of oxygen and/or ventilator support, steroid microbiological test results as well as pathological test results were collected from the patient records retrospectively. The data was compiled and analysed for association with development for mucormycosis. Results: The most common fungal species isolated in the study was Rhizopus species (53.33%). The most common clinical presentation was Nasal mucormycosis (53.33%) followed by Rhino –cerebral mucormycosis(13.3%) and Sino-nasal mucormycosis (13.3%).Diabetes mellitus was the most common associated co-morbidity(66.7%). Microscopy for fungal elements positivity was 66.67% while culture positivity was 85.7%.Culture and Histopathology findings correlated well clinically. Conclusion: Mucormycosis in COVID -19 was associated with deranged blood sugar levels either due to poorly controlled diabetes or steroid therapy. Fungal microscopy helped in early diagnosis while culture and histopathology could be employed together reliably for confirmatory diagnosis.

Prosthetic Rehabilitation of Post Covid Rhino-orbito Cerebral Mucormycosis

Covid 19 infection leads to reduced ciliary function, cytokine storm, thrombo-inflammation, microvascular coagulation and immune exhaustion. Hence, opportunistic infections such as mucormycosis are increasing in Covid affected patients. Covid infection has a tendency to worsen comorbid conditions like diabetes, hypertension, and cardiac disorders or even cause these life-threatening conditions in previously normal individuals. Corticosteroids used for the treatment of Covid puts the patients at risk of developing infections like mucormycosis since corticosteroids act as immune suppressors. At this juncture it is important to understand the pathophysiology, surgical/medical treatment as well the prosthetic rehabilitation of post covid rhino-orbito cerebral mucormycosis.

Rhino Orbital Cerebral Mucormycosis in Covid-19 Crisis.

Rhino-Orbital cerebral Mucormycosis (ROCM) an angioinvasive fungal infection commonly seen in diabetic and immunocompromised patients. In recent days, due to COVID 19 pandemic mucormycosis has been significantly increased (Smith et al. in Radiol Cardiothorac Imaging 2(5):e200280, 2020). In this study we evaluate the involvement, clinical features, contributing risk factors and outcome of post covid Rhino orbital cerebral mucormycosis. A cross sectional descriptive study was conducted on post covid rhino orbital cerebral mucormycosis patients from May 2021 to October 2021 in Otorhinolaryngology department of Stanley Medical college Chennai. We collected detailed history of Covid-19 hospital stay, treatment taken, co morbidities, Endoscopic findings, management and outcome. 243 cases analysed with median age 51years (range 28-75years) and male predominance with M:F ratio 1.6. The median time interval between covid and ROCM was 20 (15-35) days. Based on involvement 111 (46%) Stage-II, 87 (36%) Stage-I, 37 (15%) stage III and 8 (3%) stage IV disease observed. with overall mortality of 5.7%. Among which 230 (94.6%) patients had diabetes mellitus, 111 (45.8%) patients received steroid and 134 (54.3%) had immunomodulators during covid management. Despite of surgical debridement and antifungal therapy 14 (5.8%) patients died from mucormycosis. we conclude that covid be the predisposing factor for mucormycosis especially in patients with diabetes and increased usage of steroids. Treatment needs multimodality approach with antifungals and surgical debridement with surveillance fir good outcome.

Review on mucormycosis – A gloom epoch

Mucormycosis recently known with the term as black fungus belongs to the Zygomycetes family. It is a filamentous non-septate fungus. Mucormycosis is not a novel disease, although it is becoming more well-known as a result of the extensive transmission of COVID-19-associated mucormycosis. COVID-19 is currently undergoing a catastrophic phase, which is being exacerbated by the devastating spread of mucormycosis. Mucormycosis identifies the target site by exploiting conditions such as immunocompromised health, steroid therapy, and diabetes that predispose patients to infection. Mucormycosis is more prevalent in India due to the relatively high percentage of diabetics in the population causing cutaneous mucormycosis, pulmonary mucormycosis, rhino-orbital cerebral mucormycosis, and gastrointestinal mucormycosis. It is a potentially fatal condition, and this review will provide an overview of the causative organism and its effects on human lives.

Isolated cerebral mucormycosis: A case discussion

We report a case of a 32-year-old male with a history of type 1 diabetes, inhaled drug use, and alcohol use disorder, who presented with encephalopathy, holocranial headaches, neck pain, confusion, and generalized tonic-clonic seizures. The patient initially presented at a rural community hospital with a fever and was found to be in diabetic ketoacidosis (DKA). He was also hemodynamically stable but stuporous, prompting intubation to protect his airway. Despite initial treatment measures, his neurological condition worsened and he remained ventilator-dependent. Key findings include a high glucose level, presence of ketones, and evidence of drug use. Blood cultures showed no growth, but his febrile state persisted. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis, hyperglycorrhachia but normal protein, with no growth. Neuroimaging showed right hemispheric slowing on EEG and diffusion restriction in the right frontal lobe on MRI. The patient's neurological status worsened on the second day of admission, manifesting as sluggish pupillary reflexes, right third nerve palsy, and decerebrate posturing. Emergent MRI suggested cerebral edema, leading to initiation of hypertonic saline. This case highlights the diagnostic challenges and critical management considerations in a patient with multiple comorbidities presenting with unexplained neurological deterioration, emphasizing the importance of a comprehensive and timely approach to diagnosis and treatment.

AN INSTITUTIONAL STUDY ON COVID-19 ASSOCIATED RHINO-ORBITAL-CEREBRAL MUCORMYCOSIS

Background: Prior to the COVID-19 pandemic, the prevalence of mucormycosis in India was approximately 0.14 cases per 1000 population. With the second wave of the COVID-19 pandemic, there has been a tremendous increase in the number of Rhino-Orbital mucormycosis cases with a high mortality of 30.7%.This paper discusses the institutional experience of 67 cases of rhino–orbital–cerebral mucormycosis related to COVID-19 infection. Methods: In this case series, 67 proven cases of COVID-19 associated rhino-orbital-cerebral mucormycosis were analyzed retrospectively from April 2021 to March 2022. Clinical profile of all the patients were studied for signs and symptoms at presentation, possible risk factors and comorbidities. Microbiological and imaging studies was done in all patients and taken up for surgical management which included open or endoscopic debridement, maxillectomy, orbital decompression, orbital exenteration etc. Postoperatively patients were started on parenteral antifungal and discharged on oral antifungal after repeat imaging and endoscopy to rule out residual or recurrent disease. Results: The mean age of presentation was 49.1 years. Diabetes and use of steroids during covid treatment was seen in 91% and 83.5% of cases respectively. Unilateral headache and nasal obstruction were the most common symptoms. Open debridement using Weber Ferguson incision and medial maxillectomy was the most common surgical approach followed in our institution with good recovery and less chances of need for revision surgery. Conclusion: Timely diagnosis and intervention in the form of thorough surgical debridement and antifungal therapy are critical aspects in improving clinical outcomes in such patients.

Coronavirus Disease 2019-Associated Cerebral Mucormycosis in an Immunocompetent Child

AbstractMucormycosis is a rare opportunistic fungal infection observed in immunocompromised individuals or in those with uncontrolled diabetes mellitus. During the coronavirus disease 2019 (COVID-19) pandemic, there has been a steep increase in the incidence of mucormycosis among adults. However, the infection is extremely rare in the pediatric population, and its occurrence post-COVID-19 infection has been reported in very few cases. We present a case of cerebral mucormycosis in a 6-year-old immunocompetent girl that was histopathologically confirmed by stereotactic brain biopsy. The fungal infection occurred following asymptomatic COVID-19 infection. This report describes the diagnostic journey and management. It highlights the unusual presentation of cerebral mucormycosis in our case and the role of posaconazole in the successful treatment.