European Journal of Molecular & Clinical Medicine

Rhino-Orbital-Cerebral Mucormycosis (ROCM) was an emerging threat among patients with Covid-19 during the pandemic year of 2021. Diagnosis of the disease in its early phase was crucial. A study was carried out to evaluate the role of CT and MRI in diagnosing and monitoring the treatment of Rhino-Orbito-Cerebral Mucormycosis and assess the disease’s outcome.
 
The characteristic imaging findings helped in accurately diagnosing the disease.  Some key diagnostic findings were; the involvement of the periantral fat favoring angioinvasive disease;  and empty turbinate sign correlating pathologically with fungal hyphae. Tiny focal air lucencies within the permeative pattern of bone destruction were exclusively seen in fungal osteomyelitis. Another important feature of the disease seen in our study was the “pseudo empty sinus sign” from mild enlargement/widening of predominantly the ethmoid and sphenoid sinuses due to the filling of the sinuses with fungal hyphae. The affected sinuses exhibited signal void/hypointense signal on T2 subtle iso-intense signal on T1 with mild patchy enhancement in the post-contrast study.

Background: COVID-19 has been one of the worst pandemics that hit the humans. Mucormycosis in people with COVID-19 have been increasingly reported world-wide, in particular from India. Rhino-Orbito-Cerebral Mucormycosis is the most common form of it. Intracranial involvement of mucormycosis increased the fatality rate to as high as 90%.
 Aim and Objectives: To assess the clinical manifestations of the patients with post COVID-19 mucormycosis and to study steroids and oxygen usage in such patients.
Materials and Method: This retrospective cross-sectional study was carried out in the Department of Ear, Nose and Throat, Grant medical college and Sir JJ Group of Hospitals, Mumbai, from Oct 2020 to September 2022.

Aim: The COVID-19 global pandemic had resulted in a rise in a spike of Mucormycosis (black fungus) in COVID-19 individuals and diabetes is a standalone risk factor for both severe COVID-19 and black fungus, especially in India. We sought to find out how often CAM (Covid 19-associated Mucormycosis) was among both diabetes and non-diabetic individuals.
Method: The data was gathered from Kaushik pathology Lab, Barara, Ambala, Haryana. The study includes 300 patients divided into 2 groups. Both the groups comprise of 150 patients each. Group 1 consist of patients with diabetes whereas group 2 comprise of non-diabetic patients. Prevalence of CAM was then noted in both the groups.
Result: The study showed that in group 1, 74.4% cases were reported as CAM and 25.6% cases were identified as non-CAM whereas in group 2, only 38.4% CAM cases were reported in non-diabetic patients and majority of them (61.6%) were evaluated as non-CAM. A significant difference was also observed between the prevalence rate of both the groups (P < 0.05).
Conclusion: A significant difference in the CAM cases of both the groups was observed. Interestingly diabetic patients were found to be more prevalent to be infected with CAM. Further, it was concluded that New-onset diabetes was the predominant risk factor for CAM in our study. COVID-19 being other important ones for Mucormycosis in COVID-19 patients.

Mucormycosis is an invasive fungal illness associated strongly with COVID-19 and found lethal in many cases. Rhino-orbital-cerebral mucormycosis (ROCM) is the most common mucormycosis infection. The worldwide disease concern for ROCM has grown recently following the spike in incidence during the COVID-19 pandemic. This study shows the clinical characteristics and therapeutic outcomes of patients with ROCM.
Material and Methods: A retrospective observational study on 77 patients with ROCM was performed between March 2021 and June 2021 at a tertiary care hospital. This study only included patients who were microbiologically tested and conformed for ROCM. Numerous clinal diagnosis tests were performed to examine vision, paralysis of the eye muscles, eyeball protrusion, orbital swelling, extra-ocular movements, fundus examination, and extent of orbital involvement on MRI.
Results: This study of 77 patients, showed a higher ratio of male patients (74.04%) for ROCM cases. The average age of all patients was 49.14 years, and 62 (80.52%) were detected for COVID in the past. These patients were hospitalised for a minimum of 1 day to a maximum of 127 days, with an average of 40.48 days. Type 2 diabetes was found in 40 (52%) cases, while hypertension was the second most common comorbid condition observed in 21 (27.27%) cases. Amphotericin B injection was the preferred therapeutic drug shown in this study for 44 patients out of 56 who used any medication. Exenteration was also shown as a possible therapy that was performed on 53.25% of patients.
Conclusion: ROCM is more prevalent in diabetic male patients of 50 years of age infected by SARS-CoV2 who have had a later bacterial or fungal illness exacerbated by SARS-CoV2. Amphotericin B injection and exenteration could be the best possible therapeutic solution for treating ROCM.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic in India, having caused 29 500 000 confirmed cases and 374 000 deaths as of June 14, 2021, continues to have devastating consequences, including a large epidemic of COVID-19-associated mucormycosis (COVID-Mucor), manifesting as rhino-orbito-cerebral mucormycosis (ROCM), which has worsened the morbidity among vulnerable populations (JHU, 2021) ¹. Reports have shown a much larger surge in the incidence of COVID-Mucor during the second wave in 2021 than during the first wave (Patel et al., 2021; Moorthy et al., 2021) ^{2, 3}. This rapid rise in COVID-Mucor is probably caused by several factors. For patients with diabetes mellitus, lockdowns, travel restrictions, and restricted access to medical care have worsened glycaemic control, the central risk factor for ROCM in India (Chakrabarti et al., 2006) ⁴. Addressing these could reduce morbidity and mortality among vulnerable populations.
Material and Methods: A Retrospective chart review was conducted in Department of General medicine Dr S N Medical College Jodhpur among population included all rhino-orbito-cerebral mucormycosis patients with Covid-19 infection who were admitted in Mucormycosis ward, Dr S N Medical College Jodhpur from Oct. 2020 to Sept 2021. Bed head tickets of all these patients were reviewed. The final outcome was noted from the bed head ticket, the outcome was correlated with random blood sugar and HbA1c level at admission.
Conclusion: Mucormycosis is angioinvasive fungal disease with significant morbidity and mortality. The disease has risen dramatically due to interplay of COVID 19 pandemic, uncontrolled diabetes and inappropriate corticosteroid use leading to pathogenic invasion and adverse outcomes. The treatment involves early detection, surgical debridement and antifungal drugs for better survival. Our study revealed an evident role of hyperglycemia as major risk factor for mucormycosis infection. Those patients who had HbA1c> 10 could not survive inspite of best treatment and those patients who survived their hospital stay was directly proportional to their HbA1c level. All those patients who had cerebral involvement could not be saved. Hence, we suggest that closely tracking the levels of blood sugar in COVID-19 patients is a valuable tool to stratify the risk that a patient will have mucormycosis.

Rhino cerebral Mucormycosis and aspergillosis are uncommon but lethal diseases in people with immunocompromised persons. These infections typically spread through inhalation , but they can also enter through ingestion and trauma. Here, presenting a case of mucormycosis and aspergillosis in a 24-year-old immunocompetent male patient with no known co-morbidities who presented initially with complaints of headache and on subsequent investigations revealed both mucormycosis and aspergillosis involving the paranasal sinuses, nose, and cerebrum. The patient was treated with amphotericin B and Posaconazole.

Background and objectives:  During the second wave of corona virus pandemic, we saw an increase in the case reports of rhino-orbital mucormycosis in patients with coronavirus disease (COVID -19) or in patients who had recovered from COVID -19 infection. We evaluated the patient characteristics and predisposing factors in these patients having mucormycosis.
Materials and method: This retrospective observational study included 84 patients with mucormycosis diagnosed during their course of COVID-19 illness between May 2021 to July 2021.Data regarding demography, underlying medical condition, extent of involvement of mucormycosis, COVID-19 status and treatment taken during COVID-19 illness were collected.
Results: Eighty-four patients presented with mucormycosis out of which 59 patients were males and 25 females. Majority were in the age group of 40-60 years (71.4%). Rhino-orbital was the most common form of mucormycosis. Intracranial spread was noted in 16 patients. Hyperglycemia at presentation (either pre-existing or new onset diabetes mellitus) was the single most important risk factor observed in majority of these cases (80 patients / 95.23%) followed by history of Corticosteroid use in 68 patients (80.95%) and oxygen administration during their course of treatment for COVID-19 illness in 64 patients. (76.19%)
Conclusion:The association between coronavirus and mucormycosis must be given serious consideration. Uncontrolled diabetes and over-zealous use of corticosteroids are the two most important factors aggravating the illness. All efforts must be made to maintain optimal glucose levels in COVID-19 patients and use corticosteroids judiciously.

Background: Nasal endoscopy is a procedure to examine the nasal and paranasal sinus passages with 0 degree nasal endoscopes. Mucormycosis is an aggressive, life-threatening invasive fungal infection affecting paranasal sinuses, orbits and brain. Early diagnosis of mucormycosis  is possible with   diagnostic nasal endoscopy (DNE) in  covid and post covid  high risk patients.
Objective: To substantiate the need of nasal endoscopy in high risk covid and post covid patients.
Materials and Methods: Covid (48) and Post covid (64) patients (both male and female) underwent diagnostic nasal endoscopy at tertiary care hospital during period of Jan 2021 to Dec 2021. All study subjects were screened with nasal endoscopy in ENT OPD. On nasal endoscopy the target area showed eschar or blackish discolouration of turbinates and septal perforation. MRI (PNS+ORBITS+BRAIN) with contrast was carried out in suspected patients to know the extent of invasive fungal infection. All symptomatic patients were screened by opthalmologists to see extent of invasion.
Results-Out of 112 patients, 70 patients were asymptomatic while only 42 patients were symptomatic for fungal invasion.  Out of 70 asymptomatic patients, 52 patients   were positive for fungal infection. Chronic diabetes mellitus and newly diagnosed diabetes mellitus (95 patients) was common co-morbidity associated with fungal positive HPR sampling.(71 patients).
Conclusion -Follow up of the high risk post covid patients, for sequeale with diagnostic nasal endoscopy should be mandatory as majority of our patients are asymptomatic.  Patient may present with atypical symptoms like earache, nasal polyposis so high degree of suspicion is essential.    Besides mucormycosis, coinfection with aspergillus also observed in our study. So reporting of such cases is also important. A coordinated effort from a multidisciplinary team including otorhinolaryngology, ophthalmology, neurosurgery, critical care, microbiology, and pathology department is also important. A delay of initiating treatment of mucormycosis may lead to  gross rise in morbidity and mortality rate

Background and aims: During the second wave of coronavirus disease 2019 [covid-19] in India, there is a rapid surge of opportunistic fungal infections among covid-19 patients. Rhino-Orbito-Cerebral mucormycosis is the most common disease among these patients apart from pulmonary aspergillosis. The study aims to determine the clinical presentation, signs, and symptoms in patients with rhino-orbito-cerebral mucormycosis associated with coronavirus disease in the present scenario.
Methods: It is a retrospective observational study. The Clinical history of 100 patients from medical records with Rhino-Orbito-Cerebral mucormycosis associated with covid-19 during the months of May and June 2021 is collected and analyzed.
Results: In our study on 100 patients with mucormycosis infection 95 patients were diagnosed with covid-19 infection and 82 patients were diabetic. Among the diabetic group, 53 were chronic diabetic and 29 were detected denovo. The disease is seen most prominently in the people of the age group between 30-60yrs. Males are more affected. The urban population represented 67 percent. The chief complaints of the patients with mucormycosis related covid-19 are pain (88%), swelling/edema (79%), visual disturbance (51%), numbness over the face (47%), nasal discharge (45%). Clinical findings of the disease are, ptosis (52%), blurring/absent vision (51%), proptosis (41%), ophthalmoplegia (33%), discoloration over the face (26%) and necrosis of the soft tissues (8%).The percentage of people presented with mucormycosis between diagnosis of covid-19 infection and onset of symptoms of mucormycosis is observed to be 72% within two weeks and 89% within three weeks. Regarding the covid-19 symptoms, mild symptoms were seen in 59.9%, moderate symptoms in 29.4% and severe symptoms in 10.5% of patients. 76 patients were on corticosteroid therapy and 35 patients were oxygen-dependent.

Background:Mucormycosis has been increasingly described in patients with covid 19
2nd wave (delta variant) which is a highly contagious disease caused by SARS-COV-2 is
the leading cause of global pandemic. AIM AND OBJECTIVES: To evaluate etiology,
indications, management options and complications in patients managed with
endoscopic and external maxillectomy after mucormycosis, to evaluate the incidence
and distribution of cases who had extensive mucormycosis and to evaluate the outcome
of the management options.
Materials and Methods: This is a prospective study done in 30 cases at a tertiary care
centre.All the patients were subjected to detailed history taking, clinical
examination,endoscopic,radiological,pathological,microbiological investigations after
taking informed consent. Patients with age group(30yrs -70yrs) who presented with
ROM with extensive maxillary sinus involvement and destruction of different walls of
the maxillary sinus were managed with different types of maxillectomies.
Results: In this study, 30 cases of post covid rhinoorbital mucormycosis who presented
to our hospital were studied,among male 24(80%) & females6 (20%).12 patients (40%)
were in 5th to 6th decade and 9 patients (30%) in 4th to 5th decade.Main presenting
features were unilateral cheek pain,cheek swelling,nasal obstruction,loosening of teeth,
tooth ache, cheek numbness, headache,periorbital edema,visual disturbances being
present in 95% of the patients.5% presented with epistaxis,ptosis,diplopia alone.90%
patients were known case of diabetes milletus,10% are denovo diabetes.All the patients
were subjected to routine blood investigations, microbiological,
radiologicalinvestigations.(CT,MRI contrast- PNS,Orbit & Brain).Most commonly seen
in males 80%. 1 patient had to undergo orbital exenteration,3 patients underwent
palatal resection.
Conclusion: Debridement of sinuses is necessary in all cases of mucormycosis so that the
fungal reservoir could be removed and the antifungal therapy can reach the viable
areas. Therefore the management of mucormycosis is individualised to each patient
based on the extension of the disease and overall general conditon of the patient

Aim: To evaluate the mucormycosis cases in post Covid-19 patients.
Methods: This cross-sectional observational study was carried out in the Department of
Microbiology. Basic microbiological methods such as gram stain and KOH smear were
used for the detection of MC in the received clinical specimen and morphology was seen
in the microscope. Patients admitted in our hospital with a history of fever, cough, body
ache and shortness of breath for 4-5 days with have positive report of nasopharyngeal/
oropharyngeal swab for covid19 RT-PCR were included in the present study.
Results: Age, sex and other demography details were collected before sample collection,
the average age of the participants was 60.4 ± 7.5 years and the majority of participants
were male 75%. Although, 45% participants belong to below 50 year age and 55% of
participant belongs to above 50 year age. Out of n=50 specimens, total 9 specimen found
positive for fungal smear i.e. n=6 sputum, n=3 nasal swabs and n=0 BAL specimens.
Conclusions: The present study concluded that the cases of life threatening MC increase
day by day in central India as post complication of covid-19 disease.

Background: Mucormycosis is a rare disease of immunocompromised adults largely
restricted to the diabetic community with uncontrolled hyperglycaemia. In the second
wave of Covid, in multiple cities over the Indian Peninsula, this much dreaded “black
fungus” has afflicted many individuals who suffered from covid or were recovering
from it.
Aim: To establish the risk factors, clinical presentation, diagnostic sensitivities,
radiological survey of different types of mucormycosis in SARS Cov 2 patients.
Methods: Seventeen patients with covid infection admitted in tertiary care hospital with
diagnosed mucormycosis between Nov 2020 to June 2021 via histopathological or
culture confirmation. This is a cross-sectional observational study where detailed
assessment of clinical profile, biochemical markers and sensitivities of diagnostic
procedures was done. The data then collected and was made into a master chart and
subjected to statistical analysis. Fischer exact test was used for statistical anaylsis.
Result:In total of 17 patients,mean blood glucose levels were compared at the onset of
symptoms of covid and mucormycosis werestatistically significant with (P=0.001). Out
of 17 patients, 11 were rhino-orbital mucormycosis, four had rhino-orbito-cerebral
mucormycosis and 2 had pulmonary mucormycosis.HbA1c >8 had significant
correlation(P=0.009) with rhino-orbital and rhino-orbito-cerebral mucormycosis
whilehigher total dosage of steroids was associated with pulmonary mucormycosis (P=
0.015. Sensitivity of culture was 64.7% in our study while histopathology was
considered gold standard.
Conclusion: Our study shows strong correlation between the long term as well as short
term glycaemic control with the onset of rhino-orbital mucormycosis while dosage and
duration of steroids with pulmonary mucormycosis.

Aims & Objectives : To compare the clinical characteristics/profiles of the patients in first and second waves of COVID-19 in India and correlate these characteristics with risk of in-hospital mortality.
Design: Observational analytical study with longitudinal follow-up. The clinico-epidemiological and laboratory profile of patients admitted in the second wave of COVID-19 will be noted at the time of admission, and they will be followed-up during their stay in the hospital to record their outcome status. Medical records will be used to record the data of COVID-19 patients admitted in the first wave.
Setting: A tertiary care centre in Bihar, India
Participants: All patients who are COVID-19 positive based on positive RT-PCR test of oropharyngeal or nasopharyngeal swab and admitted to AIIMS, Patna during the study period.
Outcome measures: The difference in clinic-epidemiological profile of patients admitted in AIIMS Patna during the first and second wave of COVID-19 and thus we attempted to discover the effects of multiple factors such as vaccination and mutant viruses on the profile of the 2nd wave. We could also correlate the outcome status of the patient with their clinic-epidemiological profile.
Results: Females were relatively more commonly affected in the second wave. Contact history was significantly higher in the second wave. Comorbidities and clinical features were mostly similar although generalized weakness and fatigue was more common in the second wave. ARDS and septic shock were less frequent in the second wave although overall mortality was slightly higher. Azithromycin, HCQ use was discontinued whereas pulse methylprednisolone started to be used frequently. Remdesevir and tocilizumab use was
European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 08, Issue 04, 2021
2083
rationalized. HFNC and NIV were better utilized in the second wave. Mucormycosis outbreak complicated the second wave. Out of 42 individuals who were partly immunized (fourteen days after 1st dose to symptom onset), 28 patients survived.

Mucormycosis is a rare angio invasive infection mainly recognized in immunocompromised patients which occurs due to the fungi mucorales. This rare fungal infection can be classified into rhino-orbitocerebral, cutaneous, disseminated, gastrointestinal, and pulmonary types. Inspiote of aggressive treatment once detected or diagnosed overall increased mortality rate is reported. This review aims in providing with brief details regarding the Etiopathogenesis of Mucormycosis, fatality of rhinocerebral Mucormycosis along with recent advances in diagnostic and treatment methods