Clinico- Radiological Imaging Features of Covid-19 Associated Rhino-Orbital-Cerebral Mucormycosis in a Single Tertiary Care Centre: A Case Study of 20 Patients

Abstract

Introduction: Even after more than one year following the origin of the pandemic the pathogenesis of COVID-19 remains partially understood and understanding of the same continues to evolve with time. As the highly infectious virus continues to give rise to new cases globally, one of the biggest concerns is superadded infections. Superadded infections are deemed to occur as the pandemic tends to overlap with geographical realm and seasonality for few infections or due to the encounter with other community or nosocomial pathogens (during hospitalization for COVID-19). However, information on superadded infections in COVID-19, especially with relation to invasive fungal infections, is lacking. Materials and Methods: We evaluated the Retrospective, descriptive imaging and clinical data of 20 patients (thirteen males and seven females). Between 30 to 72 years old, with mucormycosis of the craniofacial areas. Patients were selected for study if the diagnosis of mucormycosis was established by means of computed tomography (CT) scans and magnetic resonance (MR) BOSS (Brain-Orbit-Sinus study with IV contrast) protocol imaging. Biopsy&culture were available for confirmation of diagnosis. All of the patients were immunocompromised. Patients with impaired renal function were excluded.Results: Of the 20 patients who had CT scans available for review, 12 patients (60%) had hyperdense in relation to muscle/brainin the noninvasive sinusitis suggesting secondary obstructive changes (inspissated secretions). Only 8 patients (40%) had iso to hypodense lesions relative to muscle/brain. On Magnetic Resonance Imaging,12 patients (60%) had hyperintense lesions relative to brain on T1-weighted images & 13patients (65.00%) had hypointense on T2-weighted images.Conclusion: We propose that, patients with COVID-19 infection are susceptible to mucormycosis because of impairment of barrier defense, dysfunction of phagocytes and lymphocytes and the use of immunosuppressive medications such as steroids, tocilizumab, high ferritin levels, use of prolonged oxygenation & COVID-19 virus itself as a risk factor. Treating clinicians need to be aware of the possibility of mucormycosis, in such patients particularly in those with underlying comorbidities. Early diagnosis and treatment of secondary fungal infections can substantially reduce morbidity and mortality. In our opinion, the severe immunocompromised state secondary to poorly controlled diabetes made the patient susceptible to both severe COVID-19 and mucormycosis.