A fungal epidemic amidst a viral pandemic: Risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis in India

A fungal epidemic amidst a viral pandemic: Risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis in India

To study the risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) during the COVID-19 pandemic in India. Multi-centric retrospective case-control study conducted from October 2020 to May 2021. Cases comprised of consecutive patients of COVID-19-associated RO...

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Bibliographic Details
Published in:Orbit (Amsterdam) Vol. 42; no. 1; pp. 30 - 41
Main Authors: Vasanthapuram, Varshitha Hemanth, Gupta, Roshmi, Adulkar, Namrata, Nair, Akshay Gopinathan, Bradoo, Renuka A, Hegde, Raghuraj, Singh, Usha, Tadepalli, Sameeksha, Mukherjee, Bipasha, Kamal, Saurabh, Alam, Md Shahid, Rao, Raksha, Ananthakrishna, Sushma, Backiavathy, Varsha, Murthy, Ajay Krishna, D'Cunha, Lynn, Dudeja, Gagan, Joji, Annie, Kiran, Anjali, Koka, Kirti, Goswami Mukhopadhyay, Moupia, Nisar, Sonam Poonam, Rao, Priyanka R., Shinde, Chhaya A.
Format: Journal Article
Language:English
Published: England Taylor & Francis 02-01-2023
Subjects:
Blood Glucose
Case-Control Studies
COVID-19
COVID-19 - epidemiology
COVID-19 Drug Treatment
diabetes mellitus
Eye Diseases
Female
Humans
India
India - epidemiology
Male
Middle Aged
mucormycosis
Mucormycosis - epidemiology
orbit
Orbital Diseases - diagnostic imaging
Orbital Diseases - epidemiology
pandemic
Pandemics
Retrospective Studies
rhino-orbital-cerebral mucormycosis
Risk Factors
second wave
steroid
Steroids
vaccination
India
COVID-19
rhino-orbital-cerebral mucormycosis
diabetes mellitus
orbit
pandemic
mucormycosis
second wave
India
steroid
vaccination
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Summary:To study the risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) during the COVID-19 pandemic in India. Multi-centric retrospective case-control study conducted from October 2020 to May 2021. Cases comprised of consecutive patients of COVID-19-associated ROCM (CA-ROCM) presenting at the participating ophthalmic institutes. Controls comprised of COVID-19-positive or COVID-19-recovered patients who did not develop ROCM. Comparative analysis of demographic, COVID-19 infection, treatment parameters and vaccination status between cases and controls performed. Clinical and imaging features of CA-ROCM analyzed. There were 179 cases and 361 controls. Mean age of presentation in cases was 52.06 years (p = .001) with male predominance (69.83%, p = .000011). Active COVID-19 infection at the time of presentation of ROCM (57.54%, p < .0001), moderate to severe COVID-19 (p < .0001), steroid administration (OR 3.63, p < .00001), uncontrolled diabetes (OR 32.83, p < .00001), random blood sugar >178 mg/dl were associated with development of CA-ROCM. Vaccination showed a protective effect (p = .0049). In cases with intracranial or cavernous sinus extension there was history of steroid administration (OR 2.89, p = .024) and orbital apex involvement on imaging (OR 6.202, p = .000037) compared to those with only rhino-orbital disease. Male gender, active COVID-19 infection, moderate or severe COVID-19, uncontrolled diabetes, steroid administration during COVID-19 treatment are risk factors for developing rhino-orbital-cerebral mucormycosis. Vaccination is protective. Random blood sugar of >178 mg/dl in COVID-19 positive or recovered patients should warrant close observation and early detection of ROCM. Presence of ophthalmoplegia, blepharoptosis at first clinical presentation and orbital apex involvement on imaging are associated with intracranial extension in ROCM.
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ISSN:0167-6830
1744-5108
DOI:10.1080/01676830.2021.2020851