Rhinomaxillary Mucormycosis Research Articles

Prosthetic rehabilitation of a patient with COVID-associated mucormycosis

Mucormycosis is a deep invasive mycotic infection caused by a group of molds referred to as mucormycetes. The incidence of mucormycosis increased markedly in the wake of the COVID-19 pandemic. The disease can be fatal in a very high percentage of individuals and in others, its effects can drastically affect the quality of life. The prognosis depends on the early diagnosis and treatment in which dental professionals play a major role, particularly in cases of rhinomaxillary mucormycosis. The present report describes the prosthetic management of a case of rhinomaxillary mucormycosis for functional restoration.

A hospital-based observational study on clinical and radiographic findings in COVID-19 associated rhinomaxillary mucormycosis

Mucormycosis is a rare, rapidly spreading, fulminant, opportunistic infection that is caused by a group of filamentous molds. During the second wave of COVID-19 India reported most of the cases of mucormycosis which is termed as COVID-19-associated mucormycosis (CAM). Aim: The purpose of this study is to describe and understand the clinical and radiographic findings related to COVID-19 associated rhinomaxillary mucormycosis. Methods: In this observational study 76 individuals with proven rhinomaxillary mucormycosis were included. The demographic profile, predisposing factors, anatomic structures involved, oral manifestations, radiographic findings management, and 90-day mortality were recorded and analyzed. Results: Among 76 individuals with COVID-19-associated rhinomaxillary mucormycosis diabetes mellitus was present in 93.42% of cases. Almost all patients received corticosteroids during COVID-19 treatment. The maxilla was most commonly involved in around 98.6% of cases. Interestingly 1 case involving the mandible was noted and the maxillary sinus was the most commonly involved. Mortality occurred in 1.31% (n=1) of cases. Conclusion: Diabetes was the most common predisposing factor. Administration of corticosteroids was evident. A considerable number of patients developed diabetes during the treatment of COVID-19. Early signs and oral manifestations of rhinomaxillary mucormycosis play a pivotal role in the early diagnosis and prompt treatment to reduce mortality and morbidity in COVID-19 associatedrhinomaxillary mucormycosis patients.

Rhino Maxillary Mucormycosis During the Covid-19 Third Wave: A Case Report

Rhino Maxillary Mucormycosis During the Covid-19 Third Wave: A Case Report

Studying the use of a proposed three-level grossing protocol in the histopathological diagnosis of COVID-19-associated rhinomaxillary mucormycosis.

Mucormycosis is an acute and rapidly progressing opportunistic fungal infection. COVID-19-associated mucormycosis (CAM) had re-emerged as a complication of COVID-19 infection during the second wave of the pandemic in 2021. The rhinomaxillary form is a variant of the rhino-cerebral mucormycosis that presents a diagnostic challenge to the dentist and the oral and maxillofacial pathologist. Gross examination of pathological specimens is the most undermined step even though it plays a vital role in the final diagnosis. No studies have described this post-clinical step for the maxillofacial soft and hard tissue submitted for examination. A prospective comparative study was carried out on 52 COVID-19-associated rhinomaxillary mucormycosis (CARM) cases to achieve complete, representative, and informative sampling of the submitted tissue and establish a three-level gross macroscopic examination protocol. Complete clinical and radiological histories were recorded after informed, written consent from every patient was received. Details of the number and type of samples received were recorded, grossing procedure was done as per the proposed three-level grossing protocol and were then compared to the presence of fungal hyphae in the soft tissue or decalcified hard tissue. All 100% of the samples consisted of soft tissue (maxillary sinus lining), while 90.4% of the samples contained different hard tissue specimens. Seventy percent of the grossing workload was carried out by first-year oral pathology residents. Sixty-seven point three percent of the total soft tissue samples submitted showed no presence of fungal hyphae, while 69.2% of total decalcified sections of hard tissue were positive for fungal hyphae with a positive correlation. Out of the 29 cases grossed via the three-level grossing protocol, 89.6% of the cases were histopathologically positive for fungal hyphae. Thus a positive association (P < 0.05) between histopathological diagnosis and the proposed three-level grossing protocol was found. It is imperative to recognise that no mucormycosis report is to be signed out without multi-site (three-level grossed) bone decalcified reports. There is an immediate need to realise how vital documentation, correct laboratory practices, and grossing are for accurate histopathological diagnosis.

Clinical and radiographic assessment of periodontal status among patients with post-COVID mucormycosis: A cross-sectional study.

An escalation in cases of rhinomaxillary mucormycosis among post-COVID patients is being reported. However, there is limited information about periodontal features in mucormycosis cases. This study explored the periodontal signs and symptoms among post-COVID mucormycosis individuals. This cross-sectional study was carried out with a total of 25 post-COVID mucormycosis patients attending tertiary care public teaching hospital. Clinical and radiographic assessments were done. An elevation in mean probing pocket depth (PPD) up to 6.21 ± 2.7 mm was noted. Nearly 16%-40% of patients had Miller's Grade III mobility in the affected site. Forty-four per cent had localized single or multiple abscess, 40% had palatal swelling, 32% had necrosis of soft tissue and bone exposure, and 52% had maxillary dentoalveolar segmental mobility in the affected site. Radiographic examination revealed varying stages of interdental bone loss. The present study observed an increase in mobility and mean PPD which did not commiserate with interdental bone loss in the affected maxillary region.

A New Diagnostic Criteria and Grading System of Rhino-Maxillary Mucormycosis based on Cone Beam Computed Tomographic Findings.

Mucormycosis is a rare opportunistic fungal infection, which has a rapidly progressive and fulminant course with fatal outcome. It is the need of the hour to diagnose and treat the increasing cases urgently. The aim of this article is to study the common radiographic features of rhinomaxillary mucormycosis (RMM), find diagnostic criteria, and grade the disease according to the radiographic features. This study was conducted at Face Three-Dimensional Cone-Beam Computed Tomography (CBCT) Center, Aurangabad, Maharashtra. CBCT scans of 30 patients who were referred for CBCT scanning of suspected RMM were retrospectively evaluated for relevant radiological data. The most common CBCT features of RMM were osteolytic lesions in alveolar bone, palate, nose and nasal cavity, and zygoma along with involvement of paranasal sinuses. About 76.66% of patients had a history of COVID-19 infection. According to the collected data, the scans of probable rhinomaxillary mucormycosis were graded in three groups - mild, moderate, and severe. The goal of this article is to emphasize the most overlook diagnostic entity - CBCT and its significant importance in early diagnosis, treatment, and prognosis of RMM. Early diagnosis of RMM can save the patients from the extent of morbidity and mortality.

Site-Based Comparative Analysis of Sample Collection Through Direct Biopsy and Nasal Swabs for Early Diagnosis of Post-COVID Rhinomaxillary Fungal Infection Using Potassium Hydroxide Mounting: A Retrospective Cohort Study.

To perform site-based comparative analysis for samples collected from the nasal region and oral cavity subjected to microscopic detection of fungal hyphae in KOH mount in a group of patients with rhinomaxillary mucormycosis. Forty patients fulfilled eligibility criteria. The diagnostic outcome of detection of fungal hyphae from the KOH samples obtained was the primary endpoint of the study. Based on this, the samples were grouped into three groups viz-oral, nasal and both. The secondary outcome was to check if there was any diagnostic delay in these three groups of patients. The mean number of days for delayed diagnosis for oral site involvement was 56.33 ± 37.53, for nasal involvement was 32.86 ± 19.53 and for both oral and nasal involvement was 22.00 ± 12.94. This difference was statistically significant at p = 0.03. The mean delay in diagnosis was significantly less when both oral and nasal regions are involved as compared to the only oral region involved at P = 0.01. To avoid the chance of delayed diagnosis or false-negative results, it is best to collect samples from both nasal tissues and the most representative site in the dentoalveolar segment depending on the extensiveness of the disease.

Outcome of Open Surgery in Disease Progression of Post-COVID Rhinomaxillary Mucormycosis Treated by Functional Endoscopic Sinus Surgery and Proposed Evaluation Scale for Maxillary Sinus Disease and Osteomyelitis.

IntroductionRhinomaxillary Mucormycosis (RMM) is a condition peculiarly seen as post-COVID-19 opportunistic infections with Maxillary Sinus Disease and Osteomyelitis (MSDO). The open method of debridement and closed method are two types of surgical modalities available. There is no scoring method for this infection in maxilla. This paper aims to study the clinical and CT-based outcome of open versus closed surgery of MSDO in post-COVID-19 RMM and propose a new scoring method to evaluate the disease severity, progression as well as recovery.Material and MethodsSymptomatic cases of RMM (n = 17) with a history of closed surgical treatment were enrolled for this prospective clinical study. These cases were then treated by medicinal and open surgical method. The clinical and CT scan outcomes were compared by proposed new scoring method.The CT-based score for Maxillary Sinus Disease (MSD) and Maxillary Osteomyelitis (MO) from pre-FESS (CT1), Post-FESS (Preoperative, CT2), and Post-operative (CT3) were compared for both right and left sides. One-way ANOVA test and post HOC tests were used for statistical evaluation.ConclusionThe open method of maxillary sinus surgery has given significant improvement in the treatment of RMM already treated by a closed endoscopic approach.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12663-022-01803-5.

COVID-19 associated rhinomaxillary mucormycosis

During COVID-19 pandemic, fulminant deep fungal infection started emerging in India, known as Mucormycosis. This type of mucormycosis was termed as COVID-19 associated mucormycosis (CAM). These patients had previous history of COVID-19 infection. Such cases were mainly reported in immunocompromised patients such as patients with poorly controlled diabetes and chronic renal diseases etc. Rhinomaxillary mucormycosis is an aggressive, fulminant, fatal deep fungal infection of head and neck region. Early diagnosis and prompt treatment can reduce the mortality and morbidity associated with the disease; hence we present case series of rhinomaxillary mucormycosis to create awareness amongst dental surgeons.

COVID-19 Associated Mucormycosis with Newly Diagnosed Diabetes Mellitus in Young Males - A Tertiary Care Experience.

Introduction Patients with a history of or active COVID-19 infection are predisposed to the development of opportunist bacterial and fungal infections. A rising incidence of a rare occurring fungal infection earlier, called mucormycosis, has been reported in abundance across the globe since March 2021, especially in India just as the second wave of COVID-19 began, caused by the trifecta of hyperglycemia (new-onset or exacerbation of pre-existing diabetes), oxygen therapy (invasive or noninvasive ventilation), and prolonged intake of steroids. Objective The present study aimed at assessing the prevalence of post-COVID mucormycosis in males of younger age group and spread of rhino-orbital-cerebral mucormycosis (ROCM). Methods A case-control study was performed over a period of 3 months among 60 male patients with confirmed diagnosis of mucormycosis. Individuals < 40 years old were included in the case group ( n = 30), while those > 40 years old were included as controls ( n = 30). Disease spread was assessed in three types of ROCM, that is, rhinomaxillary, rhino-orbital, and rhino-orbito-cerebral mucormycosis. Results In the control group, the mean age was 48.47 years old, the mean HbA1c was 10.62 ± 1.88%, with most of them suffering from rhino-orbital mucormycosis. In the case group, the mean age was 31.57 years old, with a mean HbA1c of 10.11 ± 2.46%, and most patients had rhinomaxillary mucormycosis. The duration of steroid intake and mode of oxygen therapy were found to be significant in the severity of ROCM. Conclusion Rising cases of post-COVID mucormycosis have brought to light the fatal consequences of prolonged use of steroids and oxygen therapy towards the development and spread of ROCM among young and middle-aged males.

Rhino-maxillary mucormycosis in COVID 19-diabetic patients with early oral manifestations: A retrospective study

The current COVID-19 pandemic has created yet another healthcare issue, with the emergence of a fungal disease that has resulted in a higher fatality rate. COVID-19 patients are predisposed to fungal infections such as mucormycosis, which has been reported in patients who are currently battling and those who have recently recovered, particularly those who are medically compromised. There has been a recent increase in the incidence of rhino--maxillary mucormycosis, which has become an emerging problem. We report the cases of rhino-maxillary mucormycosis presenting with early oral manifestations to help in early diagnosis and treatment. Methods: We retrospectively investigated fourteen cases of rhino-maxillary mucormycosis presenting initially with oral findings in post-COVID-19 diabetic patients who reported to the Department of Dental surgery, Andhra Medical College, Visakhapatnam, India. Statistical analysis: The data were analyzed for age distribution, gender variation, presence of particular clinical signs and symptoms, and correlation of clinical and histopathological and radiological findings. Using statistical software SPSS V2, the Student t-test and chi-square test were applied to the data. P-value equal to or less than 0.05 is considered statistically significant (P&lt;0.05). Results: There was a statistically (P&lt;0.05) significant gender variation, males showed marked predominance(79%), prominent age distribution observed in middle age (40-60 y) when compared to younger and older age group, and a significant correlation between clinical, histopathological and radiological findings were observed. Conclusions: Rhino-maxillary mucormycosis is a fatal, emerging fungal infection in COIVD- 19 diabetic patients requiring multidisciplinary surgical and medical management. It is observed that early oral manifestations are present in these patients; early detection of these cases through a thorough examination and proper interpretation of clinical and other investigatory findings may prevent the further worsening of infection, helps to save the patient’s life and to make the better prognosis of this deadly disease.

Correlation Between the New Delta Variant B.1.617.2 of COVID-19 Virus and Mucormycosis – An Invasive Fungal Infection

COVID-19 (Coronovirus disease 2019) is a pandemic involving the respiratory tract that emerged in China during late 2019 and has been spreading around the world. This pandemic, now in its second year has shown no signs of slowing down or relief and mutations of the virus have been suspected to have increased the number of cases globally. The new DELTA variant B.1.617.2 of Coronovirus SARS-CoV-2 infections is associated with a wide range of conditions, from fungal and bacterial infections to life threatening pneumonia and is categorized as a Variant of Concern (VoC). These co-infections are usually associated with preexisting morbidities (Diabetes mellitus, High blood pressure, lung infections and immuno-compromised conditions) or may also develop from hospital acquired ventilator associated pneumonia and long term steroid therapy. Very few publications on COVID-19 patients suffering from fungal infections like mucormycosis have been reported. We report eleven cases of rhino-maxillary mucormycosis in COVID-19 recovered patients who were under home-isolation. Mucormycosis in COVID-19 positive patients will require an early diagnostic intervention to ensure effective treatment. Globally, physicians and doctors should be alert and be aware of this VoC causing invasive fungal infections (IFI) in COVID-19 patients.

Post Covid-19 and Dentistry Revealing the silent condition - Rhino Maxillary Mucormycosis

&#x0D; The author would like to highlight the uncommon condition of rhinomaxillary mucormycosis which presents with a common complaint of periodontal abscess. This is highly significant in the current global scenario of the Covid-19 pandemic, as this deadly condition if diagnosed timely (by the dental surgeon) can save lives and prevent serious lifelong morbidity. Acute lung damage in Covid-19 was controlled worldwide by administering corticosteroids. This led to transient hyperglycemia, which coupled with low immunity served as an ideal environment for the fungal spore’s growth and proliferation.1 Species like Candida, Aspergillus and Rhizopus are normally not virulent in healthy individuals but can cause disseminated fatal infections in an immune-compromised host.2 Infection caused by these opportunistic pathogenic fungi present with non-specific symptoms and are often difficult to diagnose. Mucormycosis is the third most common opportunistic fungal infection caused by Rhizopus.3 Two such cases reported to the Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi with similar oral findings and common history of Covid-19 recovery. Both the patients were on 3 weeks of steroid therapy during which they had transient hyperglycemia. After 4 weeks of recovery, they developed painful gum boil/s. Clinical findings revealed periodontal abscess and tooth mobility.&#x0D;

RHINOMAXILLARY MUCORMYCOSIS IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT

Mucormycosis is an opportunistic fungal infection having a high fatality rate. Mostly it is associated with immunocompromised patients. However, mucormycosis in immunocompetent individuals has been reported in several cases throughout the world with a high incidence of such cases from the Indian subcontinent. Here, we report one such case of rhinomaxillary mucormycosis in immunocompetent patient who presented with nasal obstruction.

Proposal for a Novel Grading System for Rhino-Maxillary Mucormycosis Based on the Analysis of 30 Cases

We analyzed the data of 30 randomly selected individuals, who had visited a maxillofacial radiology centre in a span of 30 days. The aim was to find a correlation of mucormycosis with various predisposing factors and the clinical progression of the disease in order to develop a system that helps the professionals and the people to detect the condition early and minimize the morbidity and mortality. We graded the patients based on their symptoms, clinical features, and CBCT findings into Grade 1 - mild cases. Grade 2 - moderate cases. Grade 3 - severe cases. Successful management of mucormycosis is based on early detection, multimodal treatment approach, including reversal or discontinuation of underlying predisposing factor, early administration of active antifungal agents at the optimal dose, complete removal of all infected tissues and the use of various adjunctive therapies.

Cone beam computed tomography: A diagnostic aid in rhinomaxillary mucormycosis following tooth extraction in patient with diabetes mellitus

Mucormycosis is a fatal, opportunistic deep fungal infection caused by genera Rhizopus, and compromised systemic health of the patient predisposes to this condition. Rhino maxillary or rhino nasal form of mucormycosis begins after the inhalation of fungal spores and invasion into the nasal mucosa, and spreads to the paranasal sinuses. This infection can also extend into orbits and intracranium causing fatal rhino orbito-cerebral mucormycosis. Hence early intervention is very significant in terms of prognosis. The aim of current paper is to report a case of rhinomaxillary mucormycosis involving palate, nasal and maxillary sinus in an uncontrolled diabetic patient following tooth extraction highlighting the etiopathogenesis, spread of this infection and cone beam computed tomography (CBCT) features.

Comparison of fluconazole and itraconazole for treatment of rhinomaxillary mucormycosis

Aim: Rhinomaxillary mucormycosis (RMM) is a detrimental and progressive deep fungal infection which predominantly affects immunocompromised patients. The disease has heterogeneity in clinical manifestation and presents with unfavorable consequences. Despite recent advances in the diagnosis and treatment, the disease has inadequate prognosis overall. The aim of our study is to compare Fluconazole vs. Itraconazole for the management of RMM.Methods: We retrieved demographic, clinical, radiological and histopathological data of patients affected with osteomyelitis in head and neck region and 33 patients exclusively affected with RMM were separated from departmental records. Several characteristics such as Gender, age, Diabetic status, co-morbidity were observed. Patients were randomly distributed in two groups with respect to the azole drug prescribed to them. Group A was given Fluconazole while group B was given Itraconazole. Aggressive surgery with concomitant use of antifungal drug was the mandatory treatment in all patients. Regular monitoring of side effects of drugs and recurrence was carried out for prolonged time.Results: Overall, 18 patients were male and 15 patients were female with a ratio of M:F 1.2. Mean age of patients was 48.21 (11.66) with the age range from 25 years to 70 years. Out of 33 patients, 30 of the patients (90.9%) were diabetic. Fifteen patients in Group A were managed with Fluconazole while 18 patients in group B were treated with Itraconazole. There was no statistically significant difference observed in most of the clinical signs and symptoms presented in both groups as p&gt;0.05 except for bone necrosis (P=0.381). In group A, 4 patients exhibited recurrence (26.6%) while in group B, 5 (27.7%) patients presented with recurrence (p=0.943).Conclusion: Aggressive surgical approach along with supportive antifungal medication remained the mainstay of the treatment. Between Fluconazole and Itraconazole there was no difference observed.

Rhinomaxillary mucormycosis – Current perspectives in diagnosis and management

Rhinomaxillary mucormycosis – Current perspectives in diagnosis and management

Worth of Time Challenge and Multi Disciplinary Team in Rhino Maxillary Mucormycosis Mortality Detraction: Longitudinal Study in Al-Salam Teaching Hospital

Worth of Time Challenge and Multi Disciplinary Team in Rhino Maxillary Mucormycosis Mortality Detraction: Longitudinal Study in Al-Salam Teaching Hospital

Management of rhinomaxillary mucormycosis with Posaconazole in immunocompetent patients

Mucormycosis is an opportunistic, uncommon and serious systemic fungal infection mostly presenting in immunocompromised patients. The combination of surgical debridement, parenteral therapy with Amphotericin B and management of the underlying systemic disease is the standard treatment modality for mucormycosis. The drawback of this regime is the need for long hospitalization due to the serious side effects of Amphotericin B requiring regular monitoring. Oral Posaconazole is one of the newer antifungals that have shown promising results. This paper highlights a case series of rhinomaxillary mucormycosis in immunocompetent patients diagnosed and managed successfully with surgical debridement and oral Posaconazole administration on out-patient basis.