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COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum

Authors
  • Dubey, Souvik
  • Mukherjee, Debaleena
  • Sarkar, Peyalee
  • Mukhopadhyay, Pradip
  • Barman, Debasis
  • Bandopadhyay, Manimoy
  • Pandit, Alak
  • Sengupta, Amitabha
  • Das, Sudip
  • Ghosh, Soumitra
  • Adhikari, Souvik
  • Biswas, Partha Sundar
  • Pal, Pranabananda
  • Roy, Himadri
  • Patra, Nilanjana
  • Das, Amrita
  • Sinha, Pallab
  • Mondal, Md. Karimulla
  • Shrivastava, Smiti Rani
  • Bhattacharya, Kumkum
  • And 12 more
Type
Published Article
Journal
Diabetes & Metabolic Syndrome
Publisher
Diabetes India. Published by Elsevier Ltd.
Publication Date
Sep 01, 2021
Volume
15
Issue
5
Pages
102267–102267
Identifiers
DOI: 10.1016/j.dsx.2021.102267
PMID: 34509790
PMCID: PMC8407938
Source
PubMed Central
Keywords
Disciplines
  • Original Article
License
Unknown

Abstract

Aims: 1 Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2 Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. Methods Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. Results Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. Conclusions New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.

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