Cerebral Mucormycosis Research Articles

Anaesthesia for awake craniotomy in covid 19 recovered patient with cerebral mucormycosis

A 71-year-old male patient with cerebral Mucor mycosis was referred from a local COVID-19 treatment facility. Written informed consent was obtained from the patient for publication of the patients’ details and images. The patient had an awake craniotomy and had a gross total tumour excision. There was no need to switch to general anaesthesia, The operation lasted four hours and thirty minutes. Throughout the awake craniotomy, the patient was haemodynamically stable, calm, cooperative, and comfortable. Amphotericin infusion administered at the end of the surgery, and Dexmedetomidine infusion administered after skin closure and the patient was completely awake and responsive when he was transferred out of the operating room and the patient's neurological condition improved post-surgery. On post-operative day 5, a repeat COVID-19 test came out negative, and the patient was discharged. A thirty-day post-operative assessment confirmed the patient's increasing motor gain. Although maintaining analgesia and hemodynamic stability with the patient awake was challenging, a target-controlled propofol infusion gave the required level of awareness, fentanyl titrated analgesia and sedation without drug accumulation, and bupivacaine blockade provided appropriate analgesia. We came to the conclusion that our patient's anaesthetic method was effective and It is possible to do an awake craniotomy in a COVID-19 positive patient with the requisite PPEs.

A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion

Rhinocerebral mucormycosis is an opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi and is known to be rare in occurence. This infection can result in a rapid death. Rhinocerebral mucormycosis is known to commonly affect individuals who are in an immunocompromised state. Isolated cerebral mucormycosis, in the absence of rhino-orbital focus, is an extremely rare but life-threatening infection of central nervous system that is most commonly found in intravenous drug abuser. We present a case of isolated cerebral mucormycosis that presented as a case of malignant glioma and was later diagnosed as a case of cerebral mucormycosis by open biopsy and treated with antifungals. A 45-year-old male patient presented to the casualty with complaints of altered behaviour and speech with right hemiparesis for 1 week. He also lost continence of micturition and defecation. Though the patient was conscious, his presenting GCS was E4V1M6. He had suffered from COVID-19 infection 2 months back and recovered without any steroid medications. An MRI (tumour protocol) of the brain and a CECT brain revealed a high grade multicentric glial neoplasm involving left thalamocapsular region and extending into adjacent cortical/subcortical left high parietal and posterior temporal lobe and a midline shift of 6-8mm to the right. A left parietal craniotomy was done which revealed a pus-filled cavity which was drained, and marsupialization of cavity wall was done. Biopsy revealed the final diagnosis of Isolated cerebral Mucormycosis. Isolated Cerebral mucormycosis is a rare occurence and a confusing presentation and thus, an intracranial SOL should be approached with caution to minimize patient morbidity.

Combination polyene-anidulafungin therapy for isolated cerebral Rhizopus mucormycosis

Abstract Rationale: Mucormycosis is a rare fungal infection most commonly seen in immunocompromised patients or those with poorly controlled diabetes mellitus. Mucormycosis is exceedingly rare in immunocompetent hosts. Patient concerns: We present an unusual case of isolated cerebral mucormycosis in a young injection drug user. Diagnosis: The diagnosis of cerebral mucormycosis was made using stereotactic brain biopsy and tissue culture. Interventions: The patient was treated with a combination of amphotericin B and anidulafungin. Outcomes: Although the patient experienced residual neurologic deficits, she was able to resume many independent activities. Lessons: Although isolated cerebral mucormycosis is rare, it has an extremely poor prognosis. The most significant risk factor for isolated cerebral infection is injection drug use, which is likely secondary to the injection of drugs contaminated with Rhizopus spores. These patients typically present with brain abscesses in the basal ganglia. In critically ill patients and in those who fail polyene monotherapy, a combination of amphotericin B-anidulafungin therapy may provide survival benefits. Further study of synergy and combination therapy for isolated cerebral mucormycosis must be conducted before clinical conclusions can be drawn.

Cerebral mucormycosis as a new phenotype of post-COVD-19 neurological syndrome

Cerebral mucormycosis as a new phenotype of post-COVD-19 neurological syndrome

Clinical and histology features as predictor of severity of mucormycosis in post-COVID-19 patients: An experience from a rural tertiary setting in Central India.

Background:An upsurge in cases of rhinosinusitis with or without associated orbital and/or cerebral involvement by mucormycosis has been observed in post-COVID-19 patients. Our objective is to evaluate the clinical and histopathology features of these patients to determine the severity and develop a scoring on the extent on tissue invasion.Method:We prospectively enrolled and analyzed 95 post-COVID-19 patients who presented with the invasive mucormycosis of the head and neck region. Clinical and histology details were noted in predesigned forms. Various histology variables were graded from I to III to propose a scoring system for the severity of the disease.Results:Mucormycosis was common in males with a mean age of 46.8 ± 11 years. Facial pain was the most common presenting complaint and 77% of the patients were diabetic. Most cases (n = 59) showed a moderate degree of neutrophilic infiltrate with ⩾50% tissue necrosis and angioinvasion in three or more vessels with a fungal load of 2+/3+. Histology severity grade III was observed in patients who died from cerebral mucormycosis (n = 3) and septicemia (n = 2) and in patients who had undergone orbital exenteration (n = 6).Conclusion:The histopathology and severity score classification was directly correlated with the outcome of the patients. Further evaluation and a larger study will help to validate the proposed scoring for its clinical use in all forms and causes of mucormycosis.

Outbreak of Mucormycosis in Coronavirus Disease Patients, Pune, India.

We provide an overview of the epidemiology and clinical course of mucormycosis in the coronavirus disease (COVID-19) pandemic era. We conducted a retrospective chart review of 178 patients with clinical or diagnostic, endoscopically or histopathologically confirmed rhino-sino-orbital or cerebral mucormycosis after COVID-19 treatment during the second wave of COVID-19 in Pune, India. Median time to symptom onset from COVID-19 detection was 28 days. Moderate or severe COVID-19 was seen in 73% of patients and diabetes in 74.2%. A total of 52.8% received steroids. Eschar over or inside the nose was seen in 75%, but baseline clinical and laboratory parameters were mostly unremarkable. Bone penetration was present in ≈90% of cases, 30% had soft-tissue swelling of the pterygopalatine fossa and 7% had cavernous sinus thrombosis, and 60% had multifocal mucormycosis. Of the 178 study cases, 151 (85%) underwent surgical debridement. Twenty-six (15%) died, and 16 (62%) of those had multifocal mucormycosis.

The spectrum of radiological findings of rhino orbital cerebral mucormycosis with endoscopic and histopathological features in patients with COVID 19: A descriptive study

Background: There had been an increasing incidence of mucormycosis during the COVID-19 pandemic. Aim: This study evaluates the pattern of radiological imaging, endoscopic and histopathological features of rhino-orbital cerebral mucormycosis in patients with COVID-19 infection. Materials and Methods: The study included 31 patients with culture/biopsy-proven mucormycosis and COVID-19 infection from November 1, 2020, to December 31, 2021, in a single tertiary care centre. This study was approved by institutional ethics committee. Computed tomography (CT)/magnetic resonance imaging (MRI) images, endoscopic, and histopathological findings were retrospectively analyzed to look for the extent and pattern of disease. Statistical analysis was performed through descriptive statistics. Results: The imaging spectrum showed paranasal sinus involvement (n = 31; 100%), nasal involvement (n = 14; 45.16%), oral and palatal involvement (n = 6; 19.3%), deep neck/face space involvement (n = 25; 80.6%), orbital involvement (n = 20; 64.5%), vascular complications (n = 9; 29%), skull base involvement (n = 12; 38.7%), and cerebral involvement (n = 10; 32.2%). Endoscopy showed black necrotic tissue and slough mostly affecting middle turbinate, maxillary, and sphenoid sinuses. CT showed 100% sensitivity and specificity for the detection of sinonasal osseous erosion. Histopathology examination revealed mucormycosis as broad aseptate, predominantly 90° branching hyphae with macrophage and neutrophilic infiltration in 93.5%, granuloma in 61.3%, cavity formation in 48.4%, and angioinvasion in 77.4%. Diabetes mellitus was the predominant coexisting morbidity for mucormycosis. The mean time interval between COVID-19 diagnosis and mucormycosis was 18 days. Conclusion: CT revealed hyperdense contents within sinuses with osseous erosion; while MRI showed T2 hypointense, heterogeneously enhancing lesions with adjacent structural infiltration, orbital inflammation, cavernous sinus and internal carotid artery thrombosis, and intracranial complications such as infarct, hemorrhage, meningitis, and abscess. Neutrophilic infiltration and angioinvasion were predominant histopathological characteristics while necrosis with eschar formation was demonstrated through endoscopy.

Various surgical modalities for cerebral mucormycosis - our institutional experience, King George Hospital, Andhra Medical College, Visakhapatnam, India

Various surgical modalities for cerebral mucormycosis - our institutional experience, King George Hospital, Andhra Medical College, Visakhapatnam, India

A Cross-Sectional Study of First Hundred Cases of Rhino-Orbital-Cerebral Mucormycosis Admitted at a Tertiary Care Hospital.

With the second wave of coronavirus disease (COVID-19) Rhino Orbito Cerebral Mucormycosis (ROCM) has emerged as an epidemic in India. Early suspicion and management can reduce disfigurement and mortality. To identify the demographic and clinical profile of ROCM, its association with COVID-19 and other predisposing factors. Hospital Based Cross Sectional Observational study on first hundred consecutive patients with signs and symptoms and radiological findings suggestive of ROCM. Data collected from patient records and analyzed. Out of hundred, 72 patients were Males, 74 from rural areas, all were above eighteen years age, 35 presented with orbital and 27 with facial manifestations of ROCM. Main predisposing factors were history of COVID-19 (71%), previous hospitalization (48%), in Intensive Care Unit (5%) systemic corticosteroid therapy (48%), Diabetes, uncontrolled (45%) and new (21%). ROCM presented with orbital and facial manifestations. Main predisposing factors were Diabetes, COVID-19 and systemic steroids.

A clinicoepidemiological study of orbital mucormycosis in COVID-19 pandemic at a tertiary healthcare hospital, North-West Rajasthan, India

Background Mucormycosis is an opportunistic fungal infection with high morbidity and mortality. Purpose The aim of this study was to determine the risk factors, clinical presentation, management, and outcome of management of orbital mucormycosis during the coronavirus disease 2019 (COVID-19) pandemic. Patients and methods This is a prospective hospital-based observational study that was conducted on cases of rhino-orbital cerebral mucormycosis (ROCM) presented to a tertiary health-care center in North-West Rajasthan, India, during the second wave of COVID-19 over a period of 1 month (May 26, 2021 to June 25, 2021). The patients were followed up for 3 months. A total of 40 cases fulfilling the clinical, radiological, and pathological or microbiological criteria for the diagnosis of ROCM were included in the study. Results Out of a total of 126 mucormycosis patients, 40 had ocular manifestations ranging from lid edema, chemosis, and ptosis to severe manifestations such s ophthalmoplegia, optic neuritis, and cavernous sinus thrombosis. Rare presentations of corneal eschar and corneal ulcer were also reported. Among the 40 patients of orbital mucormycosis, 57.5% were in the age group of 51–65 years, 65% were males, 62.5% were COVID positive, 37.5% had a history of oxygen therapy during the COVID-19 illness, and 85% were not vaccinated against COVID-19. All patients with orbital involvement had rhinitis at presentation. Intravenous Amphotericin B was given to all patients. Functional endoscopic sinus surgery was done in 92.5% of the cases and orbital exenteration was done in 35% of the patients to prevent the spread of mucor and to reduce mortality. In 32.5% of the patients, retrobulbar Amphotericin B was given. The mean length of hospital stay was 24.62±11.70 days and 70% of the patients were discharged from the hospital on oral antifungal therapy. A total of 30% of the patients with cerebral involvement passed away. During the follow-up of 3 months, three (7.5%) more patients who discontinued treatment progressed to advanced disease and died, while 62.5% (25 out of 40) patients were alive with stable/regressed disease. The survival rate with retrobulbar Amphotericin B was 92.30% and with exenteration was 92.85%, which was statistically significant compared with the 5% survival rate in the cases in whom no such intervention was done. Conclusion Early diagnosis and treatment of ROCM reduced morbidity and mortality in mucormycosis patients.

Radical Orbital Exenteration Post Rhino cerebral Mucormycosis of Orbit

In this paper, we present images of radical orbital exenteration post rhino cerebral mucormycosis of orbit. Rhinocerebral mucormycosis is a devastating, rapidly progressive and often fatal opportunistic fungal infection primarily affecting people with underlying metabolic or immunological impairment. Intracranial extension of this disease is associated with high mortality. Exenteration is a mutilating procedure but can be lifesaving.

A Review on Mucormycosis Disease & Its Treatment

Mucormycosis is an angio-intrusive disease brought about by the Mucorales organism. Even though it is an uncommon condition, it is turning out to be more normal among immunocompromised patients. Rhino-orbitocerebral, cutaneous, dispersed, gastrointestinal, and pneumonic structures would all be able to be found. Notwithstanding the lively treatment, there is a generally speaking expanded passing rate. The audit's significant objective and objective are as follows: Mucormycosis Overview and Etiopathogenesis, Fatality of Rhino cerebral Mucormycosis Strategies for determination and treatment have as of late progressed. Mucormycosis is more typical in seriously neutropenia patients and people who need phagocytic action. Notwithstanding, this isn’t true on account of Patients with AIDS19. It suggests that T lymphocytes are involved. They are insufficient in forestalling parasitic expansion. Just the neutrophils are impacted. Voriconazole treatment for quite a while, essentially among the People with malignant growths of the blood and bone marrow Transfers of undifferentiated hematopoietic cells are more regular. Besides, Mucormycosis can likewise be found in individuals who don’t have any manifestations Rhino-orbitocerebral, cutaneous, dispersed, gastrointestinal, and pneumonic structures would all be found. Notwithstanding the lively treatment, there is a generally speaking expanded passing rate. Mucormycosis results from various fungi that may be innocuous and primarily affect immunocompromised patients. For this reason, the clinician must have a high index of suspicion to diagnose this disease in any of its forms when it presents in a patient with these risk factors. Starting with the host’s features and the fungus’s tropism once it invades the host, this activity discusses the manifestations of Disease, appropriate evaluation/management of mucormycosis, and highlights the role of the interprofessional team in evaluating and treating patients with this condition.

An evaluation of Mucormycosis, Outburst

Black fungus is also known as Mucormycosis, and it is occasional but threatening infection. Black fungus is caused by getting into exposure with fungus spores in the surroundings. It can also form in the skin after the fungus enters through a cut, scrape, burn, or another type of skin trauma. Fungi live in the environment, particularly in soil and decaying organic matter such as leaves, compost piles, rotten wood, particularly in soil, compost, and animal dung. This fungal infection is caused by a type of mould known as 'mucromycetes’. It should be noted that this rare fungal infection affects persons who have health issues or who use drugs that weaken the body's ability to fight the infections. There are different types of mucormycosis Trusted Source, including rhino cerebral (sinus and brain), pulmonary (lung), gastrointestinal, and cutaneous (skin) mucormycosis. The COVID-19 generates a sudden change in the interior environment of the host for the fungus, and the medical treatment administered unknowingly promotes fungal development. COVID-19 causes harm to the airway mucosa and blood vessels. It also causes a rise in serum iron, which is required for the fungus to grow. Broad-spectrum antibiotics not only kill potentially harmful bacteria but also beneficial commensals. Although antifungals such as Voriconazole prevent Aspergillosis, Mucor survives and grows due to a lack of resistance. Long-term ventilation decreases immunity, and there is conjecture that the humidifier water that is delivered along with the oxygen transfers the fungus. It is ubiquitous and found in soil and air and even in the nose and mucus of healthy people. It affects the sinuses, the brain and the lungs and can be life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS. Doctors believe mucormycosis, which has an overall mortality rate of 50%, may be being triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients. Steroids reduce inflammation in the lungs for Covid-19 and appear to help stop some of the damage that can happen when the body's immune system goes into overdrive to fight off coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients. It’s thought that this drop in immunity could be triggering these cases of mucormycosis.

Post-covid Rhino Cerebral Mucor Mycosis: Neurosurgical Experience

Post-covid Rhino Cerebral Mucor Mycosis: Neurosurgical Experience

Serum iron indices in COVID-19-associated mucormycosis: A case-control study.

BackgroundWhether dysregulated iron metabolism is associated with COVID‐19‐associated mucormycosis (CAM) remains unknown. Herein, we compare the serum iron indices in COVID‐19 subjects with and without mucormycosis.MethodsWe conducted a case–control study enrolling COVID‐19 participants with and without mucormycosis. We compared the baseline serum iron indices (iron, ferritin, total iron‐binding capacity [TIBC], unsaturated iron‐binding capacity and percentage transferrin saturation) between CAM cases and COVID‐19 controls. Additionally, we performed a multivariate logistic regression analysis to assess whether any iron indices are associated with CAM.ResultsWe enrolled 28 CAM cases (mean age 53.6 years old; 78.6% men) and 26 controls (mean age 57.2 years old; 73.1% men). Rhino‐orbital (±cerebral) mucormycosis (85.7%) was the most clinical presentation. Diabetes mellitus was more frequent in the cases than controls (75% vs. 42.3%; p = .015). Hypoxaemia during COVID‐19 illness was more common in controls than cases. The mean serum iron values (33 vs. 45 μg/dl, p = .03) and TIBC (166.6 vs. 201.6 μg/dl, p = .003) were significantly lower in CAM cases than controls. On multivariate analysis, we found a lower TIBC (odds ratio [OR] 0.97; 95% confidence interval [CI], 0.95–0.99) and diabetes mellitus (OR 5.23; 95% CI, 1.21–22.68) to be independently associated with CAM after adjusting for serum iron, ferritin and glucocorticoid therapy. The case fatality rate of CAM was 73.9%. The iron indices were not significantly different between CAM survivors and non‐survivors.ConclusionsThe CAM is associated with lower TIBC levels than COVID‐19 subjects without mucormycosis, suggesting dysregulated iron metabolism in its pathogenesis. Further studies are required to confirm our preliminary observations.

MR IMAGING OF RHINO-ORBITAL-CEREBRAL MUCORMYCOSIS IN POST COVID PATIENT: CASE SERIES

Rhino-orbital-cerebral Mucormycosis also known as orbital zygomycosis. It is a life-threatening deadly complication in post covid patient presenting as pathological involvement of nasal cavity and paranasal sinuses with extension into orbital cavity and intracranial compartment as a result of fungal infection caused by fungi in the order Mucorales, mainly Rhizopus oryzae. MATERIAL AND METHOD We present a case series of 5 patient who were biopsy/culture proven invasive rhino cerebral Mucormycosis in post covid-19 patient who were reviewed on MR imaging. MR imaging were recovered from PACS in PMCH Patna and the data was analyzed. RESULT Involvement of para nasal sinuses with adjacent fat standing was present in 100%, orbital involvement was seen in 80%, intracerebral involvement was seen in 60%, mastoiditis was present in 40% of the patient selected in our case series. CONCLUSION MR imaging is helpful in early diagnosis when there is involvement of nasal, paranasal sinus and varying degree of orbital and cranial extension and associated with varying complication

A Proposed Grading System and Experience of COVID-19 Associated Rhino Orbito Cerebral Mucormycosis from an Indian Tertiary Care Center

Mucormycosis is an opportunistic fungal infection. India faced an unprecedented increase in patients with post coronavirus disease 2019 (COVID-19) associated rhino-orbito-cerebral mucormycosis (ROCM). This study proposes a grading system which correlates the extent of the disease with the management plan. An observational study was conducted January 2021–June 2021. We identified 65 patients. Eleven patients had mild disease, 27 patients had moderate, 16 patients were severe and 11 patients were graded as very severe. The management was planned based on this grading system. Early diagnosis, aggressive surgical debridement and antifungal drug therapy is the key to improve survival in ROCM. Procedures such as endoscopic orbital clearance, sublabial maxillectomy, and modified endoscopic Denkers (MED) approach facilitate access and surgical debridement. The new grading system proposed assists in planning the approach and extent of surgical debridement.

COVID Induced Functional Exhaustion and Persistently Reduced Lymphocytes as Vital Contributing Factors for Post-COVID Rhino-orbital and Cerebral Mucormycosis in Patients with Diabetes: Report from the Indian Sub-continent.

The current pandemic of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a global, unanticipated public health crisis. Another emerging challenge is the prevalence of “black fungus”, or mucormycosis, among patients who recovered from COVID-19 infection. A retrospective study was conducted on 12 patients in a post-COVID recovery phase who developed mucormycosis. The study parameters evaluated lymphocyte count, CD4+ T cell status, and associated systemic co-morbidities for the patient, namely diabetes. The interventions during the treatment for COVID were also recorded to include administration of oxygen, ventilator assistance (invasive and non-invasive)/oxygen support, and steroid use. The possible relationship between low lymphocyte and CD4+ counts with diabetes and fungal growth was evaluated. It was observed that the majority of the patients who had a positive history for diabetes with low lymphocyte and CD4+ counts were more susceptible to opportunistic fungal infections. Most of the patients, but not all, had a history of receiving oxygen or assisted ventilation, as well as steroids, during the treatment for COVID infection. These interventions may be considered as accessory contributing factors for fungal infection. Post-exposure to SARS-CoV-2, therapies should be targeted at prevention of functional exhaustion of lymphocytes and maintaining optimal lymphocyte and subset counts in susceptible hosts for the prevention of opportunistic fungal infections. The relationship between functional exhaustion of the lymphocyte, diabetes, and COVID mandates further research.

EFFICACY OF KOH AND LACTO PHENOL BLUE STAIN FOR EARLY DIAGNOSIS OF RHINOORBITOCEREBRAL MUCORMYCOSIS

BACKGROUND: Rhino orbito cerebral mucormycosis has emerged as a complication after covid infection and in immunocompromised nd patients after 2 wave of covid infection in April to July 2021. This complication needs to be diagnose as early as possible to halt its spread to important nasal and orbital strucures. AIMS: This study aim to detect the sensitivity of different primary microbiological stain like KOH and lacto phenol blue. OBJECTIVE: Objective of study is to compare the efcacy of different microbiological stain to detect mucormycosis METHODOLOGY: Retrospective observational study CONCLUSION:Lactophenol blue should be the rst laboratory investigations to detect mucormycosis with higher efcacy than KOH stain

COVID-19 Associated Cerebral Mucormycosis

A 33-year-old female was admitted to COVID ICU after testing positive for the disease with 7 days history of fever, cough, inability to open as well as pain in the left eye, and inability to speak with right sided hemiparesis. She was known diabetic and hypertensive. Clinical examination showed presence of multiple pus points in left infratemopral region. Its microscopic examination showed wide area of necrosis along with cluster of mucormycosis.