Cargando…

Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe

Introduction Mucormycosis (black fungus) is a rare opportunistic fungal infection commonly affecting immunocompromised individuals. There has been a surge in the number of these cases during the second wave of the coronavirus disease 2019 (COVID-19) in India. Mucormycosis has been reported to occur...

Descripción completa

Detalles Bibliográficos
Autores principales: Farooq, Shaheen, Khan, Nabab A, Singh, Ajeet, Khan, Arif, Sharma, Preeti, Meena, Ritu, Jakhar, Ankita, Kumar, Mukesh, Kochar, Anju
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10372466/
https://www.ncbi.nlm.nih.gov/pubmed/37519583
http://dx.doi.org/10.7759/cureus.41010
_version_ 1785078383366897664
author Farooq, Shaheen
Khan, Nabab A
Singh, Ajeet
Khan, Arif
Sharma, Preeti
Meena, Ritu
Jakhar, Ankita
Kumar, Mukesh
Kochar, Anju
author_facet Farooq, Shaheen
Khan, Nabab A
Singh, Ajeet
Khan, Arif
Sharma, Preeti
Meena, Ritu
Jakhar, Ankita
Kumar, Mukesh
Kochar, Anju
author_sort Farooq, Shaheen
collection PubMed
description Introduction Mucormycosis (black fungus) is a rare opportunistic fungal infection commonly affecting immunocompromised individuals. There has been a surge in the number of these cases during the second wave of the coronavirus disease 2019 (COVID-19) in India. Mucormycosis has been reported to occur within a week or a few weeks post-recovery from COVID-19. The most common clinical manifestation of mucormycosis is rhino-orbital-cerebral mucormycosis (ROCM). At our tertiary care center, we initiated a prospective study to identify risk factors, study ocular manifestations, and explore medical and surgical management of orbital mucormycosis patients in the post-COVID-19 era. Material and methods This is a detailed description of a prospective observational hospital-based study. The study included 148 patients who presented with ROCM. A detailed history was taken regarding the complaint, duration, and associated risk factors. Systemic, local, and complete ophthalmic examinations were done that included assessment of extraocular movements, visual acuity, slit-lamp examination, and fundus examination. All data were recorded separately for each patient in a pre-decided proforma. Result The study group consisted of 148 patients. In our study, the highest association was with COVID-19-positive status (68.24%), out of which 57 (56.43%) were on oxygen support. Diabetes mellitus contributed next to COVID-19 with 86 (58.10%) patients with a positive history of diabetes. Seventy-one (47.97%) patients were on steroids, out of which 68 (67.32%) were COVID-19-positive and the rest (23%) were on steroids due to various systemic reasons. Rhinomaxillary involvement was present (51%). Out of 63 patients with orbital involvement, 16 (25.39%) presented bilaterally and 47 showed unilateral orbital involvement more on the right side (42.85%). The predominant location of orbital involvement was the orbital apex. The most common symptom seen in our study was nasal discharge (86.5%), and ophthalmoplegia was the most common sign. Conclusion Corticosteroids should be used with caution to prevent negative impact and potential ROCM. Good glycemic and metabolic control is crucial for treatment. Management of mucormycosis involves surgical debridement, antifungal agents, and retrobulbar amphotericin B injections. Early diagnosis and aggressive treatment are essential for success. Orbital exenteration may be necessary for advanced stages, while conservative approaches may work for earlier stages. Patient counseling is needed for cosmetic rehabilitation. A multidisciplinary approach involving various specialists is necessary.
format Online
Article
Text
id pubmed-10372466
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-103724662023-07-28 Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe Farooq, Shaheen Khan, Nabab A Singh, Ajeet Khan, Arif Sharma, Preeti Meena, Ritu Jakhar, Ankita Kumar, Mukesh Kochar, Anju Cureus Ophthalmology Introduction Mucormycosis (black fungus) is a rare opportunistic fungal infection commonly affecting immunocompromised individuals. There has been a surge in the number of these cases during the second wave of the coronavirus disease 2019 (COVID-19) in India. Mucormycosis has been reported to occur within a week or a few weeks post-recovery from COVID-19. The most common clinical manifestation of mucormycosis is rhino-orbital-cerebral mucormycosis (ROCM). At our tertiary care center, we initiated a prospective study to identify risk factors, study ocular manifestations, and explore medical and surgical management of orbital mucormycosis patients in the post-COVID-19 era. Material and methods This is a detailed description of a prospective observational hospital-based study. The study included 148 patients who presented with ROCM. A detailed history was taken regarding the complaint, duration, and associated risk factors. Systemic, local, and complete ophthalmic examinations were done that included assessment of extraocular movements, visual acuity, slit-lamp examination, and fundus examination. All data were recorded separately for each patient in a pre-decided proforma. Result The study group consisted of 148 patients. In our study, the highest association was with COVID-19-positive status (68.24%), out of which 57 (56.43%) were on oxygen support. Diabetes mellitus contributed next to COVID-19 with 86 (58.10%) patients with a positive history of diabetes. Seventy-one (47.97%) patients were on steroids, out of which 68 (67.32%) were COVID-19-positive and the rest (23%) were on steroids due to various systemic reasons. Rhinomaxillary involvement was present (51%). Out of 63 patients with orbital involvement, 16 (25.39%) presented bilaterally and 47 showed unilateral orbital involvement more on the right side (42.85%). The predominant location of orbital involvement was the orbital apex. The most common symptom seen in our study was nasal discharge (86.5%), and ophthalmoplegia was the most common sign. Conclusion Corticosteroids should be used with caution to prevent negative impact and potential ROCM. Good glycemic and metabolic control is crucial for treatment. Management of mucormycosis involves surgical debridement, antifungal agents, and retrobulbar amphotericin B injections. Early diagnosis and aggressive treatment are essential for success. Orbital exenteration may be necessary for advanced stages, while conservative approaches may work for earlier stages. Patient counseling is needed for cosmetic rehabilitation. A multidisciplinary approach involving various specialists is necessary. Cureus 2023-06-26 /pmc/articles/PMC10372466/ /pubmed/37519583 http://dx.doi.org/10.7759/cureus.41010 Text en Copyright © 2023, Farooq et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Ophthalmology
Farooq, Shaheen
Khan, Nabab A
Singh, Ajeet
Khan, Arif
Sharma, Preeti
Meena, Ritu
Jakhar, Ankita
Kumar, Mukesh
Kochar, Anju
Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe
title Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe
title_full Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe
title_fullStr Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe
title_full_unstemmed Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe
title_short Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe
title_sort orbital mucormycosis: understanding the deadly fungus sweeping the globe
topic Ophthalmology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10372466/
https://www.ncbi.nlm.nih.gov/pubmed/37519583
http://dx.doi.org/10.7759/cureus.41010
work_keys_str_mv AT farooqshaheen orbitalmucormycosisunderstandingthedeadlyfungussweepingtheglobe
AT khannababa orbitalmucormycosisunderstandingthedeadlyfungussweepingtheglobe
AT singhajeet orbitalmucormycosisunderstandingthedeadlyfungussweepingtheglobe
AT khanarif orbitalmucormycosisunderstandingthedeadlyfungussweepingtheglobe
AT sharmapreeti orbitalmucormycosisunderstandingthedeadlyfungussweepingtheglobe
AT meenaritu orbitalmucormycosisunderstandingthedeadlyfungussweepingtheglobe
AT jakharankita orbitalmucormycosisunderstandingthedeadlyfungussweepingtheglobe
AT kumarmukesh orbitalmucormycosisunderstandingthedeadlyfungussweepingtheglobe
AT kocharanju orbitalmucormycosisunderstandingthedeadlyfungussweepingtheglobe