Aastha Gandhi1, Anurag Narula2, Shreya Chandra2, Dhwanee Agarwal2, Anuj Mehta2, Shaktiprada Nayak3, Sheetal Arora4, Malini R Capoor5. 1. Department of Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India. aastha1009@yahoo.co.in. 2. Department of Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India. 3. Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. 4. Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. 5. Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Abstract
PURPOSE: The most recent challenge being faced by the healthcare system during the worldwide COVID-19 pandemic is increase in the incidence rate of coinfection or superinfection; one of the most fatal being mucormycosis. This study aimed to estimate the risk factors, symptoms and signs, treatment outcome and prognosis of COVID-19-associated mucormycosis (CAM) patients. METHODS: This is an interventional study of 35 patients diagnosed and managed as CAM at a tertiary care centre in New Delhi, India. RESULTS: The mean age of patients was 40.45 ± 6 years with a male preponderance. CAM did not affect healthy individuals; the major risk factors included diabetes in 65.7% and injudicious steroid use in 51.4% patients. Orbital/facial edema was the most common presenting symptom (25.7%) as well as sign (28.57%). 68.5% patients were stage 3 (involvement of orbit) at presentation; 33.3% showed medial wall involvement. Treatment included intravenous Amphotericin and oral Posaconazole in all patients, paranasal sinus (PNS) debridement in 94.2%, orbital exenteration was done in 8 patients. Adjuvant retrobulbar Amphotericin B injection was administered in 12 patients with radiological resolution seen in 50% after 1 cycle. In patients with Stage 4 disease who underwent exenteration along with PNS debridement, survival rate was 100% at 30 days, and disease reduction occurred in 87.5% patients (P < 0.01). Overall, 68.5% responded to therapy, 8.5% showed progression and mortality rate was 22.85%, at a mean follow up period of 59.5 days. CONCLUSION: A multidisciplinary and aggressive approach is essential in the management of CAM patients.
PURPOSE: The most recent challenge being faced by the healthcare system during the worldwide COVID-19 pandemic is increase in the incidence rate of coinfection or superinfection; one of the most fatal being mucormycosis. This study aimed to estimate the risk factors, symptoms and signs, treatment outcome and prognosis of COVID-19-associated mucormycosis (CAM) patients. METHODS: This is an interventional study of 35 patients diagnosed and managed as CAM at a tertiary care centre in New Delhi, India. RESULTS: The mean age of patients was 40.45 ± 6 years with a male preponderance. CAM did not affect healthy individuals; the major risk factors included diabetes in 65.7% and injudicious steroid use in 51.4% patients. Orbital/facial edema was the most common presenting symptom (25.7%) as well as sign (28.57%). 68.5% patients were stage 3 (involvement of orbit) at presentation; 33.3% showed medial wall involvement. Treatment included intravenous Amphotericin and oral Posaconazole in all patients, paranasal sinus (PNS) debridement in 94.2%, orbital exenteration was done in 8 patients. Adjuvant retrobulbar Amphotericin B injection was administered in 12 patients with radiological resolution seen in 50% after 1 cycle. In patients with Stage 4 disease who underwent exenteration along with PNS debridement, survival rate was 100% at 30 days, and disease reduction occurred in 87.5% patients (P < 0.01). Overall, 68.5% responded to therapy, 8.5% showed progression and mortality rate was 22.85%, at a mean follow up period of 59.5 days. CONCLUSION: A multidisciplinary and aggressive approach is essential in the management of CAM patients.
Authors: Oliver A Cornely; Ana Alastruey-Izquierdo; Dorothee Arenz; Sharon C A Chen; Eric Dannaoui; Bruno Hochhegger; Martin Hoenigl; Henrik E Jensen; Katrien Lagrou; Russell E Lewis; Sibylle C Mellinghoff; Mervyn Mer; Zoi D Pana; Danila Seidel; Donald C Sheppard; Roger Wahba; Murat Akova; Alexandre Alanio; Abdullah M S Al-Hatmi; Sevtap Arikan-Akdagli; Hamid Badali; Ronen Ben-Ami; Alexandro Bonifaz; Stéphane Bretagne; Elio Castagnola; Methee Chayakulkeeree; Arnaldo L Colombo; Dora E Corzo-León; Lubos Drgona; Andreas H Groll; Jesus Guinea; Claus-Peter Heussel; Ashraf S Ibrahim; Souha S Kanj; Nikolay Klimko; Michaela Lackner; Frederic Lamoth; Fanny Lanternier; Cornelia Lass-Floerl; Dong-Gun Lee; Thomas Lehrnbecher; Badre E Lmimouni; Mihai Mares; Georg Maschmeyer; Jacques F Meis; Joseph Meletiadis; C Orla Morrissey; Marcio Nucci; Rita Oladele; Livio Pagano; Alessandro Pasqualotto; Atul Patel; Zdenek Racil; Malcolm Richardson; Emmanuel Roilides; Markus Ruhnke; Seyedmojtaba Seyedmousavi; Neeraj Sidharthan; Nina Singh; János Sinko; Anna Skiada; Monica Slavin; Rajeev Soman; Brad Spellberg; William Steinbach; Ban Hock Tan; Andrew J Ullmann; Jörg J Vehreschild; Maria J G T Vehreschild; Thomas J Walsh; P Lewis White; Nathan P Wiederhold; Theoklis Zaoutis; Arunaloke Chakrabarti Journal: Lancet Infect Dis Date: 2019-11-05 Impact factor: 25.071