Case Report: Rhino-orbital Mucormycosis Related to COVID-19: A Case Series Exploring Risk Factors

There has been a surge of rhino-orbital mucormycosis cases in India in the wake of the second wave of the COVID-19 pandemic. It has been widely suggested that dysglycemia resulting from diabetes which is a common comorbidity in COVID-19 patients, and indiscriminate steroid use has resulted in this s...

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Bibliographic Details
Published in:The American journal of tropical medicine and hygiene 2022-02, Vol.106 (2), p.566-570
Main Authors: Aggarwal, Sushil Kumar, Kaur, Upinder, Talda, Dolly, Pandey, Akshat, Jaiswal, Sumit, Kanakan, Ahalya, Singh, Anshuman, Chakrabarti, Sankha Shubhra
Format: Article
Language:English
Subjects:
Adult
Antifungal Agents - therapeutic use
Case Report
Case reports
Case-Control Studies
Comorbidity
Coronaviruses
COVID-19
COVID-19 - complications
COVID-19 - drug therapy
COVID-19 - epidemiology
Diabetes
Diabetes Mellitus - epidemiology
Eye Diseases - diagnosis
Eye Diseases - drug therapy
Eye Diseases - epidemiology
Eye Diseases - virology
Eye Infections, Fungal - drug therapy
Eye Infections, Fungal - epidemiology
Eye Infections, Fungal - virology
Female
Fungal infections
Humans
India
Male
Middle Aged
Mucormycosis - diagnosis
Mucormycosis - drug therapy
Mucormycosis - mortality
Mucormycosis - virology
Risk Factors
Steroids
Steroids - therapeutic use
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Summary:There has been a surge of rhino-orbital mucormycosis cases in India in the wake of the second wave of the COVID-19 pandemic. It has been widely suggested that dysglycemia resulting from diabetes which is a common comorbidity in COVID-19 patients, and indiscriminate steroid use has resulted in this surge. We report a series of 13 cases of rhino-orbital mucormycosis in COVID-19 patients admitted to our center between mid-April and early June 2021. The cases showed a male preponderance, two patients had loss of vision, and four of them showed intracranial extension of disease. Twelve patients had received steroids and 12 had preexisting or newly diagnosed diabetes, both steroid use and diabetes being the most common identified risk factors. Considering other possible risk factors, immunosuppressed state, antiviral or ayurvedic (Indian traditional) medications, and oxygen therapy were not associated with a definite risk of mucormycosis, because they were not present uniformly in the patients. We propose that COVID-19 itself, through molecular mechanisms, predisposes to mucormycosis, with other factors such as dysglycemia or steroid use increasing the risk.
ISSN:0002-9637
1476-1645
DOI:10.4269/ajtmh.21-0777