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VOLUME 15 , ISSUE 2 ( May-August, 2023 ) > List of Articles

Original Article

Rhino-orbital-cerebral Mucormycosis and Aspergillosis Post-COVID-19: Contrariety in Terms of Prevalence Severity Management and Prognosis at a Tertiary Care Centre in Western Rajasthan

Semridhi Gupta, Sonu Parmar, Paridhi Ahuja

Keywords : Amphotericin B, Aspergillosis, COVID-19, Diabetes mellitus (DM), Diagnostic nasal endoscopy, Maxillary sinus, Mucormycosis, Mycosis, Rajasthan, Rhinocerebral

Citation Information : Gupta S, Parmar S, Ahuja P. Rhino-orbital-cerebral Mucormycosis and Aspergillosis Post-COVID-19: Contrariety in Terms of Prevalence Severity Management and Prognosis at a Tertiary Care Centre in Western Rajasthan. Int J Otorhinolaryngol Clin 2023; 15 (2):64-69.

DOI: 10.5005/jp-journals-10003-1462

License: CC BY-NC 4.0

Published Online: 21-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: To assess the etiopathogenesis and associated morbidity of rhino-orbital fungal infections post-COVID-19. Primary objective: To study the prevalence of mucormycosis vs aspergillosis post-COVID-19 and to collate their similarities and the distinguishing features. Secondary objective: To determine the sensitivity and positive predictive value of KOH fungal staining. Materials and methods: The study was conducted as a retrospective review of 71 patients with rhino-orbital fungal infections post-COVID-19 admitted in our department from “May to August 2021” at M.D.M. Hospital, Jodhpur. The records were assessed and statistically evaluated. Results: The median age was 43 with male: female ratio 3:1. Out of 71 patients, 53 were positive for mucormycosis and 18 diagnosed with aspergillosis. Uncontrolled diabetes was associated with 94% of rhino-orbital cerebral mucormycosis (ROCM) and 77% of aspergillosis. Steroid intake was seen in 68% of ROCM and 47% of aspergillosis. Most common presenting feature was facial paresthesia/pain. Maxillary sinuses were the most involved paranasal sinuses. Orbital involvement was seen in 36% of ROCM and 32% aspergillosis. Intracranial involvement was seen in 9% of ROCM and 5% of aspergillosis. On nasal endoscopy, necrosed middle turbinate seen in 79% of mucormycosis and 11% of aspergillosis. Aggressive surgical intervention was required in 37% of ROCM and 16% of aspergillosis. Revision surgery became necessary in 13% of ROCM and 27% of aspergillosis. ROCM associated mortality was 18% in mucormycosis, whereas 0% in aspergillosis. Sensitivity of the KOH report was 94% and PPV 98%. Conclusion: A male preponderance seen that can be credited to higher smoking habits and hence susceptibility for COVID-19. The patients suffering from rhino-orbital aspergillosis and mucormycosis have almost similar underlying risk factors, clinical and radiological signs and treatment protocol but they differ in the prevalence, disease extension at presentation, aggressive/conservative surgical approach, recurrence, and mortality. Though mucormycosis comes out to be more malignant and common, rhino-orbital aspergillosis is not an unusual entity.

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