Evaluation of Prognostic Factors in Management of Associated COVID-19 Oro-facial Mucormycosis

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Dr. Qais Habeeb Musa
Hamid Ibrahim Mohammed
Hamsa Zaki Al-Assadi


Mucormycosis, COVID-19, Amphotericin-B, Diabetes Mellitus


After declaration of corona virus as pandemic in 2019, strong relationship has been showed between the sudden upsurge of mucormycosis occurrence in patients with history of COVID-19. This relation can be explained by: the effect of corona virus on patient immune system, the infection worsens the effect of the underlying predisposing factors such as diabetes mellitus and drugs therapy that were used in treatment of COVID-19 specially corticosteroid. Mucormycosis presented mainly in patient who had comorbid conditions like diabetes, steroid therapy or chemotherapy. This study showed the association between the increase in the prevalence of mucormycosis in patients with COVID-19 and proved the diabetes was the main risk factors for this fungal infection.

The study confirmed there were many factors determined the prognosis in the management of mucormycosis first of them is the early diagnosis which depends on high index of clinical suspicion, accurate procedures for diagnosis confirmation such as biopsy, fungal culture media, radiological examination by CT scan or MRI, early initiation of antifungal therapy either Amphotericin- B or Liposomal Amphotericin- B as soon as the diagnosis is confirmed and aggressive surgical debridement  of all infected tissue .

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1- Jeong, W.; Keighley, C.; Wolfe, R.; Lee, W.L.; Slavin, M.A.; Kong, D.C.M.; Chen, S.C.A. The epidemiology and clinical manifestations of mucormycosis: A systematic review and meta-analysis of case reports. Clin. Microbiol. Infect. 2019, 25, 26–34.
2- Prakash, H.; Ghosh, A.K.; Rudramurthy, S.M.; Singh, P.; Xess, I.; Savio, J.; Pamidimukkala, U.; Jillwin, J.; Varma,S.;Das,A.;etal. Aprospective multicenter study on mucormycosis in India: Epidemiology,diagnosis, and treatment. Med. Mycol. 2018.
3- Chakrabarti, A.; Das, A.; Mandal, J.; Shivaprakash, M.R.; George, V.K.; Tarai, B.; Rao, P.; Panda, N.; Verma, S.C.; Sakhuja, V. The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. Med. Mycol. 2006, 44, 335–342.
4- Kauffman, C. A., Vazquez, J. A., Sobel, J. D., Gallis, H. A., McKinsey, D. S., Karchmer, A. W., ... & National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. (2000). Prospective multicenter surveillance study of funguria in hospitalized patients. Clinical Infectious Diseases, 30(1), 14-18.‏
5- Teixeira, C. A., Medeiros, P. B., Leushner, P. & Almeida, F. 2013. Rhinocerebral mucormycosis: literature review apropos of a rare entity. Case Reports, 2013.
6- Ambrosioni, J.; Bouchuiguir-wafa, K.; Garbino, J. Emerging invasive zygomycosis in a tertiary care center: Epidemiology and associated risk factors. Int. J. Infect. Dis. 2010, 14, e100–e103.
7- Awadhesh Kumar Singh, Ritu Singh, Shashank R. Joshi,Anoop Misra. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India: Diabetes & Metabolic Syndrome: Clinical Research & Reviews 15, (2021), 102146.
8- Dhandapani M, Manne M, Mohammed L. Risk of Mucormycosis in Diabetes Mellitus: A Systematic Review. Cureus. 2021 Oct 16;13(10):e18827. doi: 10.7759/cureus.18827. PMID: 34804684; PMCID: PMC8592794.
9- Mengji AK, Yaga US, Gollamudi N, Prakash B, Rajashekar E. Mucormycosis in a surgical defect masquerading as osteomyelitis: a case report and review of literature. Pan Afr Med J. 2016;23:16.
10- Sundaram N, Bhende T, Yashwant R, Jadhav S, Jain A. Mucormycosis in COVID-19 patients. Indian J Ophthalmol 2021; 69:3728-33.
11- Veisi A, Bagheri A, Eshaghi M, Rikhtehgar MH, Rezaei Kanavi M, Farjad R. Rhino‑orbital mucormycosis during steroid therapy in COVID‑19 patients: A case report. Eur J Ophthalmol 2021;11206721211009450.doi: 10.1177/11206721211009450. Online ahead of print.
12- Ajith Kumar AK,GuptaV. Rhino‑orbital cerebral mucormycosis. StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.
13- Nishanth DG, Anitha DN, Babu DNA, Malathi DL. Mucormycosis. A review. Eur J Mol Clin Med 2020;7:1786‑91.
14- Skiada A, Lass‑Floerl C, Klimko N, Ibrahim A, Roilides E, Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol 2018; 56(suppl_1):93‑101.
15- Safder S, Carpenter JS, Roberts TD, Bailey N. The “Black Turbinate” sign: An early MR imaging finding of nasal mucormycosis. AJNR Am J Neuroradiol 2010;31:771‑4.
16- Katragkou A, Walsh TJ, Roilides E. Why is mucormycosis more difficult to cure than more common mycoses? Clin Microbiol Infect. 2014 Jun;20 Suppl 6:74-81. doi: 10.1111/1469-0691.12466. Epub 2014 Jan 28. PMID: 24279587.
17- Tissot F, Agrawal S, Pagano L et al. ECIL-6 guidelines for the treatment of invasive candidiasis, aspergillosis and mucormycosis in leukemia and hematopoietic stem cell transplant patients. Haematologica. 2017; 102: 433–444.
18- Almyroudis NG, Sutton DA, Fothergill AW et al. In vitro susceptibilities of217clinical isolates of zygomycetes to conventional and new antifungal agents. Antimicrob Agents Chemother. 2007; 51: 2587–2590. 68.
19- Roden MM, Zaoutis TE, Buchanan WL et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41: 634–653.
20- Cornely, O.A.; Alastruey-Izquierdo, A.; Arenz, D.; Chen, S.C.A.; Dannaoui, E.; Hochhegger, B.; Hoenigl, M.; Jensen, H.E.; Lagrou, K.; Lewis, R.E.; et al. Global guideline for the diagnosis and management of mucormycosis: An initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect. Dis. 2019, 19, e405–e421.
21- Revannavar SM, Supriya PS, Samaga L, Vineeth VK. COVID-19 triggering mucormycosis in a susceptible patient: A new phenomenon in the developing world? BMJ Case Rep 2021;14:e241663.
22- 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; 186:289-98.
23- Sachdeva, Shivani et al. ‘Coronavirus Disease (COVID-19) Associated Mucormycosis (CAM)’. 1 Jan. 2022 : 37 – 42.
24- Omer Sefvan Janjua , Muhammad Saad Shaikh , Muhammad Amber Fareed , Sana Mehmood Qureshi, Muhammad Ikram Khan , Danya Hashem and Muhammad Sohail Zafa. Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes. January 2022Journal of Fungi - Open Access Mycology Journal 8(1):44.
25- Hoenigl M, Seidel D, Carvalho A, et al. (2021) The Emergence of COVID-19 associated mucormycosis: Analysis of cases From 18 Countries.
26- Moorthy A, Gaikwad R, Krishna S, Hegde R, Tripathi KK, Kale PG, et al. SARS-CoV-2, uncontrolled diabetes and corticosteroids – An unholy trinity in invasive fungal infections of the maxillofacial region? A retrospective, multi-centric analysis. J Maxillofac Oral Surg 2021; 20:418-25.
27- 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;6: S5-8.
28- Peterson KL, Wang M, Canalis RF, Abemayor E. Rhinocerebral mucormycosis: evolution of the disease and treatment options. The Laryngoscope. 1997;107(7):855-62.
29- Alekseyev, K.; Didenko, L.; Chaudhry, B. Rhinocerebral mucormycosis and COVID-19 pneumonia. J. Med. Cases 2021, 12, 85
30- Elinav H, Zimhony O, Cohen MJ, Marcovich AL, Benenson S. Rhinocerebral mucormycosis in patients without predisposing medical conditions: a review of the literature. Clinical Microbiology and Infection. 2009;15(7):693-7.
31- Sharma AK, Gupta A, Singh VJ, Gabhane CK, Modi M. Mucormycosis, COVID-19, and immunosuppression – The three sides of similar triangle: Narrative review. Saudi J Oral Sci 2022; 9:10.
32- Amorim dos Santos J, Normando AG, Carvalho da Silva RL, Acevedo AC, De Luca Canto G, Sugaya N, Santos-Silva AR, Guerra EN. Oral manifestations in patients with COVID-19: a living systematic review. Journal of Dental Research. 2021;100(2):141-54.
33- Rodriguez-Morales, A.J.; Sah, R.; Millan-Oñate, J.; Gonzalez, A.; Montenegro-Idrogo, J.J.; Scherger, S.; Franco-Paredes, C.; Henao-Martínez, A.F. COVID-19 Associated Mucormycosis: The Urgent Need to Reconsider the Indiscriminate Use of Immunosuppressive Drugs; SAGE Publications Sage UK: London, UK, 2021.
34- Craig, J.R.; Tataryn, R.W.; Aghaloo, T.L.; Pokorny, A.T.; Gray, S.T.; Mattos, J.L.; Poetker, D.M. Management of odontogenic sinusitis: Multidisciplinary consensus statement. Int. Forum Allergy Rhinol. 2020, 10, 901–912.