MUCORMYCOSIS OUTCOMES IN THE COVID 19 ERA: A RETROSPECTIVE COHORT STUDY
DOI:
https://doi.org/10.69723/njms.04.04.0633Keywords:
Mucormycosis, COVID-19, mortality, immunocompromisedAbstract
ABSTRACT
Objective: To evaluate the survival outcomes and prognostic factors of patients with mucormycosis during the COVID-19 pandemic and assess treatment strategies.
STUDY DESIGN: Retrospective cohort study
PLACE AND DURATION: Department of ENT, Northwest General Hospital and Research Centre Peshawar, Pakistan, from January 2020 to December 2023.
Methodology: A cohort of 30 mucormycosis patients with comprehensive records over a three-year period was identified and extracted from the hospital's HMIS database. Clinical, radiological, and surgical data were meticulously collected. All patients underwent functional endoscopic sinus surgery (FESS) and surgical debridement, and the data were analyzed using SPSS.
Results: The mean age was 50.31±1.911 years, with 21(70%) males and 12(40%) COVID-19 positive. Disease extent included paranasal sinus (PNS) involvement 9(30%), PNS + orbital (OR)9 (30%), and PNS + OR + intracranial (IC) 11(37%). Mortality was higher in patients with extensive disease (PNS + OR + IC) at 6(54.5%) (p=0.02). COVID-positive patients had a mortality rate of 6(50%). FESS alone was performed in 18(60%) of patients, while 12(40%) required more extensive surgeries such as exenteration or external approaches with more extensive surgeries linked to worse outcomes (p=0.025).
Conclusion: Advanced age, COVID-19 positivity, and extensive disease involving the paranasal sinuses, orbit, and intracranial regions were linked to higher mortality. Patients treated solely with functional endoscopic sinus surgery (FESS) demonstrated better survival outcomes compared to those requiring more invasive procedures. While corticosteroid use and COVID-19 status correlated with disease severity, they did not significantly influence surgical outcomes. Early diagnosis, timely surgical intervention, and antifungal therapy are essential for improving survival in mucormycosis cases.
References
1. Özbek, L., Topçu, U., Manay, M., Esen, B. H., Bektas, S. N., Aydın, S., Özdemir, B., Khostelidi, S. N., Klimko, N., Cornely, O. A., & Zakhour, J. (2023). COVID-19–associated mucormycosis: A systematic review and meta-analysis of 958 cases. Clin Microbiol Infect., 29(6), 722–731. https://doi.org/10.1016/j.cmi.2023.03.008
2. Safiia, J., Díaz, M. A., Alshaker, H., Atallah, C. J., Sakr, P., Moshovitis, D. G., Nawlo, A., Franceschi, A. E., Liakos, A., & Koo, S. (2024). Recent advances in diagnostic approaches for mucormycosis. J Fungi, 10(10), 727. https://doi.org/10.3390/jof10100727
3. Singh, A. K., Singh, R., Joshi, S. R., & Misra, A. (2021). Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr., 15(4), 102146. https://doi.org/10.1016/j.dsx.2021.05.019
4. Lynch, J. P. III, Fishbein, M. C., Abtin, F., & Zhanel, G. G. (2023). Part 1: Mucormycosis: Prevalence, risk factors, clinical features, and diagnosis. Expert Opin Anti Infect Ther., 21(7), 723–736. https://doi.org/10.1080/14787210.2023.2220964
5. Al-Ani, R. M. (2022). Rhino-orbital-cerebral mucormycosis as a complication of coronavirus disease 2019. World J Virol., 11(5), 293. https://doi.org/10.5501/wjv.v11.i5.293
6. Sahni, D., Singh, P., Kaur, R., Aggarwal, S., & Kaur, A. (2023). Rising incidence of post-COVID rhinocerebral mucormycosis: An otolaryngologist’s perspective. Indian J Otolaryngol Head Neck Surg., 75(1), 1–9. https://doi.org/10.1007/s12070-022-03320-3
7. Sharma, S., Grover, M., Bhargava, S., Samdani, S., & Kataria, T. (2021). Post coronavirus disease mucormycosis: A deadly addition to the pandemic spectrum. J Laryngol Otol., 135(5), 442–447. https://doi.org/10.1017/S0022215121000992
8. Al-Tawfiq, J. A., Alhumaid, S., Alshukairi, A. N., Temsah, M. H., Barry, M., & Al Mutair, A., et al. (2021). COVID-19 and mucormycosis superinfection: The perfect storm. Infect., 49, 833–853.
9. Swain, S. K., Lenka, S., & Das, S. R. (2020). Rhino-orbital mucormycosis: A dreaded clinical entity. Int J Curr Res Rev., 12(24), 197–203. https://doi.org/10.31782/IJCRR.2020.122434
10. Honavar, S. G. (2021). Code Mucor: Guidelines for diagnosis and management of rhino-orbito-cerebral mucormycosis in COVID-19. Indian J Ophthalmol., 69(6), 1361–1365. https://doi.org/10.4103/ijo.IJO_1565_21
11. Riley, T. T., Muzny, C. A., Swiatlo, E., & Legendre, D. P. (2016). Breaking the mold: Review of mucormycosis and pharmacologic treatment. Ann Pharmacother., 50(9), 747–757. https://doi.org/10.1177/1060028016654020
12. Sipsas, N. V., Gamaletsou, M. N., Anastasopoulou, A., & Kontoyiannis, D. P. (2018). Therapy of mucormycosis. J Fungi., 4(3), 90. https://doi.org/10.3390/jof4030090
13. Singh, S. P., Rana, J., Singh, V. K., Singh, R., Sachan, R., Singh, S., & Jain, S. (2021). Rhino-orbital mucormycosis: Clinical features and management. Rom J Ophthalmol., 65(4), 339–353. https://doi.org/10.35826/rjo.2021.65.4.10
14. Chao, C. M., Lai, C. C., & Yu, W. L. (2022). COVID-19 associated mucormycosis—An emerging threat. J Microbiol Immunol Infect., 55(2), 183–190. https://doi.org/10.1016/j.jmii.2021.12.007
15. Pal, R., Singh, B., Bhadada, S. K., Banerjee, M., Bhogal, R. S., Hage, N., & Kumar, A. (2021). COVID-19-associated mucormycosis: Systematic review. Mycoses., 64(12), 1452–1459. https://doi.org/10.1111/myc.13338
16. Seidel, D., Simon, M., Sprute, R., Lubnow, M., Evert, K., Speer, C., et al. (2022). COVID-19-associated mucormycosis in Germany: Results from a national survey. Mycoses., 65(1), 103–109. https://doi.org/10.1111/myc.13379
17. Ostovan, V. R., Tabrizi, R., Bazrafshan, H., Bahrami, Z., Khazraei, H., & Borhani-Haghighi, A., et al. (2022). Mortality-related risk factors for COVID-19-associated mucormycosis: Systematic review and meta-analysis. Curr Fungal Infect Rep., 16(4), 143–153. https://doi.org/10.1007/s12281-022-00441-y
18. Dam, P., Cardoso, M. H., Mandal, S., Franco, O. L., Sağıroğlu, P., Polat, O. A., Kokoglu, K., Mondal, R., Mandal, A. K., & Ocsoy, I. (2023). Surge of mucormycosis during the COVID-19 pandemic. Travel Med Infect Dis., 52, 102557. https://doi.org/10.1016/j.tmaid.2023.102557
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