Rhino-orbital-cerebral mucormycosis as a complication of coronavirus disease 2019

Abstract

Coronavirus disease 2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus 2. This disease as well as its various treatments like steroids, antivirals, and antibacterials can alter the immune state of the affected individuals and result in secondary infections such as mucormycosis. Mucormycosis is a well-known opportunistic fungal infection that affects immunocompromised subjects, particularly those with diabetes mellitus, prolonged antibiotic or steroid use, and patients with organ trans-plantation, neutropenia, and hematological malignancies. Rhino-orbital-cerebral mucormycosis is an aggressive disease owing to its ability to invade the blood vessels by fungal hyphae, leading to necrosis of the involved structures. Large cases were reported from India, indicating that this clinical entity shows a geographical variation. The affected patients are suffering on a clinical spectrum depending on the stage of the disease. Radiological assessment, including computerized tomography and magnetic resonance imaging, is necessary to evaluate the stage of the disease and choose the appropriate surgical treatment. A multidisciplinary approach is required to treat rhino-orbital-cerebral mucor-mycosis and includes local or intravenous antifungal drugs, debridement of the dead tissues, and appropriate management of any predisposing conditions. The disease has a very poor prognosis with a death rate of 50%. This review aimed to sum-marize the demographic and clinical risk factors, investigations, treatments, and outcomes of coronavirus disease 2019 patients with rhino-orbital-cerebral mucormycosis.

Keywords: Rhino-orbital-cerebral mucormycosis, Mucormycosis, Nose and paranasal sinuses, Orbit, Cerebrum, COVID-19

Core Tip: Rhino-orbital-cerebral mucormycosis is an aggressive, opportunistic fungal infection. There is an increment in cases of this condition in the era of coronavirus disease 2019, particularly in India. It usually affects the severe or critical types of the COVID-19 and those with a history of diabetes mellitus, corticosteroid therapy, and mechanical ventilation. Early diagnosis with prompt treatment carries a better outcome. The treatment consists of intravenous or local amphotericin B, surgical debridement, and reversal of any immunocompromised conditions. However, this disease has a poor prognosis with a high rate of morbidity and mortality.