Rhino-orbital Mucormycosis Research Articles

Radiological findings of mucormycosis rhinosinusitis among Indian COVID-19 patients during the pandemic second wave

BackgroundSinonasal mucormycosis is a quickly progressing and lethal fungal disease which showed an increased incidence in COVID-19 patients in the Indian population during the second wave of the pandemic. The objective of this study was to study the various sinus areas affected and the imaging findings of the disease.MethodsThe imaging records of patients with sinonasal mucormycosis during the second wave of the COVID-19 pandemic were reviewed and analysed for whom computed tomography (CT) and/or magnetic resonance imaging (MRI) images had been performed.ResultsOf the 65 patients, 6.1% had single sinus involvement, and 93.9% had multiple sinus involvement, and out of latter, 91.8% had bilateral sinuses affected by the disease process. A total of 49.2% patients with sinus involvement had erosions of the sinus walls. A total of 35.4% patients had only sinonasal mucormycosis, 38.5% patients had rhino-orbital mucormycosis, 4.6% patients had rhino-cerebral mucormycosis and 16.9% patients had rhino-orbitocerebral mucormycosis. The pterygopalatine fossa was affected in 26.2% patients. A total of 9.2% patients had cavernous sinus thrombosis. A total of 12% of the cases had infarction in the cerebral hemispheres.ConclusionIn a setting of sinonasal mucormycosis, especially in the immuno-compromised and with those infected with COVID-19, cross-sectional imaging can assess the presence and extent of the disease and helps plan its medical and surgical management.

Rhino-Orbital Mucormycosis: A Case Series and Review of Literature

Mucormycosis (Zygomycosis) is an invasive fungal infection, often acute and extremely severe caused by opportunist and ubiquitous fungi belonging to the class Phygomycetes, subclass Zygomycetes, order Mucorales, family Mucoraceae. COVID-19 is an infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Since the first case was detected, in December 2019 in Wuhan, China. COVID-19 has been found to have many systemic manifestations. Of these, ocular presentations associated with COVID-19 have been identified. It is acquired by the implantation of the fungal spores in the oral, nasal, and conjunctival mucosa (rhino-orbito-cerebral), by inhalation (pulmonary), or by the ingestion of contaminated food (digestive). The field of neuro-ophthalmology has been affected, due to both neuro-ophthalmic manifestations of COVID-19, as well as adaptations in the delivery of health care and treatment of pre-existing conditions.

Rising Incidence of Post Covid Rhinocerebral Mucormycosis: An Otolaryngologists Prospective.

Mucormycosis or grimmer popular name, "black fungus" has evolved public concern in context of covid-19 pandemic, Covid Associated Mucormycosis (CAM) seen in Covid-19 pandemic and as a post covid sequelae. The present study was conducted to find out the incidence of the Mucormycosis, and to study its association with post-covid status and co-morbidities. A retrospective study conducted at tertiary care centre over a period of four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease. 59 patients had CAM, 47 patients had rhino-orbital Mucormycosis, followed by nasal and paranasal Mucormycosis in 8 patients, 3 patients with rhino-orbital-cerebral Mucormycosis, and one patient with pulmonary Mucormycosis. Diabetes mellitus was present in all 59 patients, 60.41% who had HbA1c > 10 (range 7-15), and 39.58% had HbA1c < 10 with range 6-13. Only 8.33% had controlled diabetes status, uncontroled hypertension and diabetes was seen in 34.02%. All patients were started with IV amphotericin B anti-fungal drug, and followed by oral posaconazole. Depending upon the extent of the disease surgical debridement was done in 52 patients. All patients had history of steroid intake. 7 mortality was there. Uncontrolled diabetes, over-zealous use of steroids, uncontrolled underlying primary disease or co-morbidities, prolonged hospitalization in intensive care unit or normal wards, and hyperventilation all these factors together aggravated the CAM. So it's proper management based on, prompt diagnosis, reversal of predisposing condition with proper medical and aggressive surgical debridement remain the corner stone for this deadly CAM.

A Case Series on COVID-19 Associated Mucormycosis (CAM): Experience from a Tertiary Care Centre in India

Aim: During the second wave of the COVID 19 pandemic, a life threatening fungal infection, mucormycosis have been detected in patients post COVID 19 disease. Commonly known as the ‘black fungus’ can causes tissue necrosis, inflammation and necrosis of the head and neck regions, paranasal sinuses, facial bones, orbits and it can also cause intracranial spread. In the current study we describe a series of cases of COVID 19 associated mucormycosis (CAM), the clinical presentations, risk factors, diagnosis, management and follow up experience from a tertiary care centre in India.&#x0D; Methods: This is a retrospective observational study conducted over a period of one year (April 2021 to April 2022) at our tertiary care centre. The diagnosis of COVID 19 was done by RT PCR (reverse transcription-polymerase chain reaction). The diagnosis of Mucormycosis was done by Histopathology and fungal cultures. The demographic details of the patients were retrieved from the medical records.&#x0D; Results: In the present study we report four cases of Rhino-orbital-cerebral Mucormycosis, three cases of Rhino-orbital Mucormycosis, two cases of Pulmonary Mucormycosis and one case of Disseminated Mucormycosis. All the patients had undergone extensive surgical debridement and received Liposomal Amphotericin B as initial antifungal medication and Posaconazole or Isavuconazole as step down therapy. Six patients responded to treatment while four patients did not have a favorable outcome and succumbed to the illness. &#x0D; Conclusion: Mucormycosis is a deadly disease with high mortality and morbidity if not diagnosed and treated at an early stage. Factors like poor control of blood sugars, inadvertent use of corticosteroids, immune dysfunction due to COVID 19 can result in poor outcome of the disease despite aggressive treatment interventions.

Spectrum of Fungal Infections in a Tertiary Care Centre of North India: Pre-COVID and COVID Scenario and Implications.

Background Rhino orbital mucormycosis is a rare and very aggressive entity. A sudden rise of this entity has been noticed with the insurgence of the COVID-19 pandemic both among immunocompromised and immuno-competent patients. This study was done to determine any possible correlation between these two deadly diseases. Materials and Methods This was a retrospective observational study done in the pathology department of a tertiary care center in North India over a three-year period (January 2019 - December 2021). Patient details along with relevant clinical data were retrieved from the patient's record file. Hematoxylin and eosin-stained slides of diagnosed cases were taken from the department records. Results A total of 45 patients (34 males, 11 females) were included in the study, seven of which were ophthalmic exenteration specimens. The mean age of the patients was 52.68 years. Fifteen cases showed COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) positivity. Histopathology revealed the presence of mucormycosis in all the cases. There were six cases showing granuloma formation and 14 cases revealed mixed fungal infection. Optic nerve involvement was seen in six cases of exenteration specimens. Conclusions The present study showed a sudden resurgence of secondary fungal infections, especially during the second wave of the COVID-19 pandemic. Associated co-morbid conditions and injudicious use of steroids and antibiotics have been the cause of depressed immunity leading to the infections. One must be aware of such co-infections to facilitate timely medical management to reduce morbidity and mortality.

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.

Deficient Phagocytosis in Circulating Monocytes from Patients with COVID-19-Associated Mucormycosis.

Cases of rhino-orbital mucormycosis in patients suffering from severe coronavirus disease 2019 (COVID-19) were reported in different parts of the world, especially in India. However, specific immune mechanisms that are linked to susceptibility to COVID-19-associated mucormycosis (CAM) remain largely unexplored. We aimed to explore whether the differential regulation of circulating cytokines in CAM patients had any potential pathogenic links with myeloid phagocyte function and susceptibility to mucormycosis. A small cohort of Indian patients suffering from CAM (N = 9) as well as COVID-19 patients with no evidence of mucormycosis (N = 5) were recruited in the study. Venous blood was collected from the patients as well as from healthy volunteers (N = 8). Peripheral blood mononuclear cells and plasma were isolated. Plasma samples were used to measure a panel of 48 cytokines. CD14+ monocytes were isolated and used for a flow cytometric phagocytosis assay as well as a global transcriptome analysis via RNA-sequencing. A multiplex cytokine analysis of the plasma samples revealed reduction in a subset of cytokines in CAM patients, which is known to potentiate the activation, migration, or phagocytic activity of myeloid cells, compared to the COVID-19 patients who did not contract mucormycosis. Compared to monocytes from healthy individuals, peripheral blood CD14+ monocytes from CAM patients were significantly deficient in phagocytic function. The monocyte transcriptome also revealed that pathways related to endocytic pathways, phagosome maturation, and the cytoskeletal regulation of phagocytosis were significantly downregulated in CAM patients. Thus, the study reports a significant deficiency in the phagocytic activity of monocytes, which is a critical effector mechanism for the antifungal host defense, in patients with CAM. This result is in concordance with results regarding the specific cytokine signature and monocyte transcriptome. IMPORTANCE A number of cases of mucormycosis, often fatal, were reported among severe COVID-19 patients from India as well as from some other parts of the world. However, specific immunocellular mechanisms that underlie susceptibility to this fungal infection in COVID-19 remain largely unexplored. Our study reports a deficiency in phagocytosis by monocytes in COVID-19 patients who are concomitantly afflicted with mucormycosis, with this deficiency being linked to a characteristic monocyte transcriptome as well as a circulating cytokine signature. The functional phenotype and cytokine signature of the monocytes may provide useful biomarkers for detecting potential susceptibility to mucormycosis in COVID-19 as well as in other viral infections.

COVID-19 and rhino-orbital mucormycosis – A case report

There is a constant rise in cases of rhino-orbital mucormycosis in people with coronavirus disease 2019 (COVID-19). Generally, mucormycosis develops in immunosuppression or debilitating diseases. In cases having head and neck involvement, the mold enters the respiratory tract with further involvement of nose and sinuses and there is consecutive progression into orbital and intracranial structures. Diabetes mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. The clinical examination and direct smears are helpful for early diagnosis of the disease and timely intervention. For the better prevention and management of such opportunistic infections in COVID-19 patients, it is prudent to establish prophylactic treatment protocols along with rational use of corticosteroids. We here report a case of rhino-orbital mucormycosis infection caused by Rhizopus oryzae in a COVID-19 patient with DM.

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.

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.

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.

Mucormycosis of mandible – A rare case series

Mucormycosis is a rare fungal infection with high morbidity and mortality rate as compare to its prognosis which is poor. Coronavirus disease 2019 (COVID-19) infection may be associated with a wide range of bacterial and fungal co-infections. We report the case of a patient with COVID-19 infection, which, during the course of the treatment, developed rhino-orbital mucormycosis. Very few cases of mucormycosis of mandible have been reported in literature. In this article, we present three cases of mucormycosis affecting mandible and the surgical management for it given in our institute. Extraction of all mobile teeth was done along with mechaincal curettage and sequestrectomy performed.Patients are kept in regular follow up and referred to Prosthodontics department for rehabilitation.COVID-19 associated mucormycosis is aggressive and locally invasive, therefore early diagnosis and management is imperative to improve prognosis and help reduce morbidity. Mandible is not affected frequently by mucormycosis but is aggressive. Caution before attempting dental extraction which can worsen ongoing infection will ensure good outcomes, shorter hospital stay and better rehabilitation.

Bloody tears as initial manifestation of rhino-orbital mucormycosis.

Bloody tears as initial manifestation of rhino-orbital mucormycosis.

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

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.

COVID-19 Associated Rhino-Orbital Mucormycosis During the Pandemic: Our Experience on Diagnostic Challenges to Management

COVID-19 Associated Rhino-Orbital Mucormycosis During the Pandemic: Our Experience on Diagnostic Challenges to Management

The Psychological Impact of Rhino-Orbital Mucormycosis During the Second Wave of COVID-19 Pandemic From South East Asian Country.

The present study addressed overcoming the lacunae in the literature of psychiatric manifestations associated with rhino-orbital mucormycosis. The current study aimed to assess the symptoms of depression, anxiety, stress, coping measures, suicidal intent, and visual disability in patients of rhino-orbital mucormycosis (ROM) during the epidemic of the disease at the nodal tertiary care center in North India. Fifty-four inpatients of laboratory-proven rhino-orbital mucor-mycosis (ROM)were included for an observational, cross-sectional study at nodal, designated COVID-19, and mucormycosis treating tertiary care hospital. Patients with Hindi Mini-Mental State Examination score <24, prior psychiatric illness, and severely ill requiring ventilator support were excluded. The psychological variables were assessed using Depression, Anxiety, and Stress Scale 21 (DASS 21), Beck's Suicide intent Scale, Coping Scale Questionnaire, and Visual disability scale (IND-VFQ33). Their socioeconomic status was assessed using the Modified Kuppuswamy Scale. Ninety percent of patients with ROM had diabetes mellitus. The majority (44%) of patients belonged to lower socioeconomic strata. Higher frequencies of severe depression (28%), extremely severe anxiety (26%), and mild stress (17%) were noted in the study participants. On the Tukey test, depression score was higher in patients of ROM compared to COVID (with ROM) (p-value= 0.016). On Tukey analysis, anxiety score was significantly higher in ROM patients compared to COVID (with ROM) patients (p-value = 0.018). Coping scores were significantly higher in COVID (with ROM) patients compared to ROM patients (p value = 0.035). Mild to moderate visual disability was noted in the study participants. Conclusion: The current study reflects the association of higher depression and anxiety scores in cases with ROM that indicated higher mental health needs. Early assessment, early detection, and early intervention for psychological help, along with themultidisciplinary team, helped toimprovethe overallpsychological outcome of the affected patients.

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.

Neuro-ophthalmic Manifestations of Coronavirus Disease 2019 and Its Vaccination: A Narrative Review.

Coronavirus disease 2019 (COVID-19) is a current pandemic caused by SARS-CoV-2 that has vastly affected the whole world. Although respiratory disease is the most common manifestation of COVID-19, the virus can affect multiple organs. Neurotropic aspects of the virus are increasingly unfolding, in so far as some respiratory failures are attributed to brainstem involvement. The neuro-ophthalmic manifestations of COVID-19 and the neuro-ophthalmic side effects of vaccination were reviewed. The major findings are that the SARS-CoV-2 infection commonly causes headaches and ocular pain. It can affect the afferent and efferent visual pathways by ischemic or inflammatory mechanisms. Optic nerve may be the origin of transient or permanent visual loss from papillophlebitis, idiopathic intracranial hypertension, or optic neuritis. Cerebrovascular strokes are not uncommon and may lead to cortical visual impairment or optic nerve infarction. SARS-CoV-2 may affect the pupillomotor pathways, resulting in tonic pupil (Adie's syndrome) or Horner's syndrome. Cranial neuropathies including third, fourth, sixth, and seventh nerve palsies have all been reported. Rhino-orbital mucormycosis superinfections in COVID-19 patients receiving steroids or other immunosuppressive therapies may result in unilateral or bilateral visual loss and ophthalmoplegia. Autoimmune conditions such as Guillain-Barré, Miller-Fisher syndrome, and ocular myasthenia have been reported.

Rhino-orbital mucormycosis in a Mexican patient with COVID-19: Case report

A variety of bacterial and fungal co-infections may be attributed to the coronavirus disease 2019 (COVID-19), particularly in people who already have a medical condition such diabetes mellitus or those who received large dosages of steroids. We described a 52-year-old diabetic man who was receiving high doses of dexamethasone and antibiotics while receiving ambulatory care for COVID-19 pneumonia. His anterior rhinoscopy revealed a necrotic scab, and a sample confirmed Mucor spp. He underwent surgery and was given amphotericin as a result of the severity of the condition, palpebral ptosis, and right ocular palsy he was experiencing. The patien ́s progression was satisfactory. pre-existing diabetes mellitus, previous steroid and antimicrobial use, as well as SARS-CoV-2 infection are some of the risk factors associated with Mucor spp. infection. Prompt detection of mucormycosis is important in the management of these affected patients.