Keywords
COVID-19
How to Cite
Abstract
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.
References
Palanisamy N, Vihari N, Meena DS, Kumar D, Midha N, Tak V, et al. Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study. BMC Infect Dis. 2021 Sep;21(1):933. doi: 10.1186/s12879-021-06647-x.
Zia M, Goli M. Predisposing factors of important invasive fungal coinfections in COVID-19 patients: a review article. J Int Med Res. 2021 Sep;49(9):3000605211043413. doi: 10.1177/03000605211043413.
Unnikrishnan R, Misra A. Infections and diabetes: risks and mitigation with reference to India. Diabetes Metab Syndr. 2020 Nov-Dec;14(6):1889-94. doi: 10.1016/j.dsx.2020.09.022.
Garg D, Muthu V, Sehgal IS, Ramachandran R, Kaur H, Bhalla A, et al. Coronavirus disease (Covid-19) associated mucormycosis (CAM): case report and systematic review of literature. Mycopathologia. 2021 May;186(2):289-98. doi: 10.1007/s11046-021-00528-2.
Oh H, Ghosh S. NF-κB: roles and regulation in different CD4(+) T-cell subsets. Immunol Rev. 2013 Mar;252(1):41-51. doi: 10.1111/imr.12033.
Jose A, Singh S, Roychoudhury A, Kholakiya Y, Arya S, Roychoudhury S. Current understanding in the pathophysiology of SARS-CoV-2-associated rhino-orbito-cerebral mucormycosis: a comprehensive review. J Maxillofac Oral Surg. 2021 Sep;20(3):373-80. doi: 10.1007/s12663-021-01604-2.
Alqarihi A, Gebremariam T, Gu Y, Swidergall M, Alkhazraji S, Soliman SS, et al. GRP78 and integrins play different roles in host cell invasion during mucormycosis. mBio. 2020 Jun;11(3):e01087-20. doi: 10.1128/mBio.01087-20.
Rai S, Yadav S, Kumar D, Kumar V, Rattan V. Management of rhinomaxillary mucormycosis with Posaconazole in immunocompetent patients. J Oral Biol Craniofac Res. 2016 Nov;6(Suppl 1):S5-S8. doi: 10.1016/j.jobcr.2016.10.005.
Dilek A, Ozaras R, Ozkaya S, Sunbul M, Sen EI, Leblebicioglu H. COVID-19-associated mucormycosis: Case report and systematic review. Travel Med Infect Dis. 2021 Nov-Dec;44:102148. doi: 10.1016/j.tmaid.2021.102148.
Patel A, Agarwal R, Rudramurthy SM, Shevkani M, Xess I, Sharma R, et al. Multicenter epidemiologic study of coronavirus disease–associated mucormycosis, India. Emerg Infect Dis. 2021 Sep;27(9):2349-59. doi: 10.3201/eid2709.210934.
Sen M, Honavar SG, Bansal R, Sengupta S, Rao R, Kim U, et al. Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India–Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1. Indian J Ophthalmol. 2021 Jul;69(7):1670-92. doi: 10.4103/ijo.IJO_1565_21.
Patel A, Kaur H, Xess I, Michael JS, Savio J, Rudramurthy S, et al. A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect. 2020 Jul;26(7):944.e9-944.e15. doi: 10.1016/j.cmi.2019.11.021.
Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021 Jul-Aug;15(4):102146. doi: 10.1016/j.dsx.2021.05.019.
Alfishawy M, Elbendary A, Younes A, Negm A, Hassan WS, Osman SH, et al. Diabetes mellitus and Coronavirus disease (Covid-19) associated mucormycosis (CAM): a wake-up call from Egypt. Diabetes Metab Syndr. 2021 Sep-Oct;15(5):102195. doi: 10.1016/j.dsx.2021.102195.
Pal R, Singh B, Bhadada SK, Banerjee M, Bhogal RS, Hage N, et al. COVID‐19‐associated mucormycosis: an updated systematic review of literature. Mycoses. 2021 Dec;64(12):1452-9. doi: 10.1111/myc.13338.
Qadir MM, Bhondeley M, Beatty W, Gaupp DD, Doyle-Meyers LA, Fischer T, et al. SARS-CoV-2 infection of the pancreas promotes thrombofibrosis and is associated with new-onset diabetes. JCI Insight. 2021 Aug;6(16):e151551. doi: 10.1172/jci.insight.151551.
Jose A, Singh S, Roychoudhury A, Kholakiya Y, Arya S, Roychoudhury S. Current understanding in the pathophysiology of SARS-CoV-2-associated rhino-orbito-cerebral mucormycosis: a comprehensive review. J Maxillofac Oral Surg. 2021 Sep;20(3):373-80. doi: 10.1007/s12663-021-01604-2.
Muthu V, Rudramurthy SM, Chakrabarti A, Agarwal R. Epidemiology and pathophysiology of COVID-19-associated mucormycosis: India versus the rest of the world. Mycopathologia. 2021 Dec;186(6):739-54. doi: 10.1007/s11046-021-00584-8.
Weprin BE, Hall WA, Goodman J, Adams GL. Long-term survival in rhinocerebral mucormycosis: case report. J Neurosurg. 1998 Mar;88(3):570-5. doi: 10.3171/jns.1998.88.3.0570.
Sosale A, Sosale B, Kesavadev J, Chawla M, Reddy S, Saboo B, et al. Steroid use during COVID-19 infection and hyperglycemia–What a physician should know. Diabetes Metab Syndr. 2021 Jul-Aug;15(4):102167. doi: 10.1016/j.dsx.2021.06.004.
Selvamani M, Donoghue M, Bharani S, Madhushankari GS. Mucormycosis causing maxillary osteomyelitis. J Nat Sci Biol Med. 2015 Jul-Dec;6(2):456-9. doi: 10.4103/0976-9668.160039.
Gudmundsson T, Torkov P and Thygesen TH. Diagnosis and treatment of osteomyelitis of the jaw – a systematic review of the literature. J Dent Oral Disord. 2017 Jun;3(4):1066. doi: 10.26420/jdentoraldisord.2017.1066.
Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021 Jul-Aug;15(4):102146. doi: 10.1016/j.dsx.2021.05.019.
Brandão TB, Gueiros LA, Melo TS, Prado-Ribeiro AC, Nesrallah AC, Prado GV, et al. Oral lesions in patients with SARS-CoV-2 infection: could the oral cavity be a target organ? Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Feb;131(2):e45-e51. doi: 10.1016/j.oooo.2020.07.014.
Amorim dos Santos J, Normando AG, Carvalho da Silva RL, Acevedo AC, De Luca Canto G, Sugaya N, et al. Oral manifestations in patients with COVID-19: a living systematic review. J Dent Res. 2021 Feb;100(2):141-54. doi: 10.1177/0022034520957289.
Sanath AK, Nayak MT, Sunitha JD, Malik SD, Aithal S. Mucormycosis occurring in an immunocompetent patient: a case report and review of literature. Cesk Patol. 2020 Winter;56(4):223-6.
Bains MK, Hosseini-Ardehali M. Palatal perforations: past and present. Two case reports and a literature review. Br Dent J. 2005 Sep;199(5):267-9. doi: 10.1038/sj.bdj.4812650.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2022 Sulem Ansari, Shivayogi Charantimath, Vasanti Lagali Jirge, Vaishali Keluskar
Downloads
