Alternating pattern of rhino-orbital-cerebral mucormycosis with COVID-19 in diabetic patients


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Eker Ç., TARKAN Ö., SÜRMELİOĞLU Ö., DAĞKIRAN M., Tanrisever I., Yucel Karakaya S. P., ...More

EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, vol.280, no.1, pp.219-226, 2023 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 280 Issue: 1
  • Publication Date: 2023
  • Doi Number: 10.1007/s00405-022-07526-0
  • Journal Name: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.219-226
  • Keywords: Rhino-orbital-cerebral mucormycosis, Orbital exenteration, COVID-19-associated mucormycosis, COVID-19 pandemic
  • Çukurova University Affiliated: Yes

Abstract

Purpose Our aim was to analyze the patients with diabetic rhino-orbital-cerebral mucormycosis that we have treated in our clinic in the last 5 years, and to reveal the altering conditions with COVID-19. Materials and methods A retrospective study was conducted on 39 rhino-orbital-cerebral mucormycosis (ROCM) patients with diabetes mellitus between 2017 and 2022. The patients were divided into two groups as those associated with and not associated with COVID-19 and compared. Results Thirty-nine diabetic patients were included in the study, with 15 (38.5%) of them being COVID-19 associated mucormycosis (CAM) group. CAM patients showed higher orbital involvement and cavernous sinus involvement (p = 0.002 and p = 0.013, respectively). The mortality rate in the non-COVID-19 associated mucormycosis (non-CAM) group was statistically higher in patients with intracranial and cavernous sinus involvement (p = 0.015 and p = 0.033, respectively). The difference between the overall survival of the CAM patients and non-CAM patients was not statistically significant (p = 0.741). Conclusions With COVID-19, progressive mucormycosis accompanied by orbital and intracranial involvement is observed more frequently. However, on the contrary, the mortality rate in COVID-19-associated mucormycosis is considerably lower than expected. The fact that temporary immune suppression can be ameliorated with adequate supportive treatment and liposomal amphotericin-B which can be given to patients in high doses may explain this situation. It has been attained hints that the essential factor in the treatment of COVID-19-associated ROCM is the control of the underlying disease and to be cautious in the decision of early aggressive surgery.