Table 1.
Characteristics of patients included in this report.
| Age/Sex | Diabetes | Comorbidities | Presentation | Site | Treatment | Outcome | Surge | Microbiology | Notes |
|---|---|---|---|---|---|---|---|---|---|
| 38/M | New onset | Sinusitis | - Nasal obstruction - Facial and orbital pain |
Sinus | L-AmB then POS | Alive | Within 24h | Mucorales | Pathology proven mucormycosis |
| 57/M | Yes | Hypertension | - Tooth pain and dysphagia - Headache |
Sinus | L-AmB + POS then POS | Alive | Within 24h | No growth |
Pathology proven mucormycosis Palatal perforation on admission |
| 48/F | Yes | Morbid obesity | - Left eye ophthalmo-plegia and ptosis - Right orbital Apex syndrome |
Rhino- orbital | L-AmB then POS | Alive | Within 48h | Mucorales and Aspergillus fumigatus | Pathology proven mucormycosis |
| 54/M | Yes | Hypertension Atrial Fibrillation Ischemic cardiomyopathy Chronic Kidney disease |
- Left facial palsy - Headache |
Rhino- orbital | L-AmB plus POS | Alive | Not done | Pseudomonus aeroginosa |
Pathology proven mucormycosis Palatal perforation on admission |
| 55/M | Yes | Hypertension | Headache | Sinus | L-AmB | Alive | Not done | NA | Improved with medical treatment only |
| 65/F | Yes | Hypertension Hypothyroidism Dyslipidemia |
Respiratory Distress | Pulmonary | AmB plus POS | Alive | Not done | - Culture grew Rhizopus, Aspergillus flavus and Aspergillus fumigatus - Has associated CAPA and Polymicrobial Carbapenem Resistant acinetobacter and klebsiella pneumonia |
- Received Tocilizumab |
| 49/F | Yes with DKA | Ischemic heart disease | Right eye ophthalmoplegia and proptosis | Rhino- orbital | AmB | Alive | Not done | Not done | Lost to follow up |
| 32/M | None | None | - Rt Periorbital oedma - Facial swelling and headache |
Rhino, orbital | ITC | Alive | Within 24h | Culture grew only Acinetobacter Baumanni |
|
| 56/M | Yes | Asthma Long Covid |
- Left orbital edema - Ophthalmoplegia and vision loss |
Rhino- orbital | AmB | Alive | Within 24h but later required orbital exentration | - Cultures grew only candida and aspergillus Sp | - Received Tocilizumab - Developed postoperative ischemic stroke |
| 52/F | Yes | Ischemic heart disease Asthma | - Left orbital edema - Ophthalmoplegia with rapid deterioration of vision |
Rhino- orbital | AmB then VRC | Alive | Within 48h but required orbital exentration | - Culture grew only Acinetobacter Baumanii | - Received Tocilizumab |
| 61/M | Yes | Ischemic heart disease | - Left facial edema - Proptosis |
Rhino- orbital | ITC | Alive | Within 72h | Negative cultures | |
| 39/M | New onset | None | - Left sided pansinusitis - Severe headache with retroorbital pain |
Sinus | ITC | Alive | Within 72h | negative culture | Fungal mud with |
| 45/F | None | None | - Left sided sinusitis - Diminution of vision with mild proptosis |
Rhino- orbital | AmB | Alive | Within 48h | - Negative cultures | - Had periseptal and orbital abscess - Immediate postoperative improvement of vision |
| 69/M | Yes | None | - Pansinusitis - Blackish discoloration of the palate - Malignant otitis externa |
Sinus | VRC | Alive | 24h | - Culture failed to grow mucor and only reported Aspergillus | - Received Tocilizumab - Had septal perforation - Required another endoscopic debridement after 2 weeks |
| 60/F | Yes | Asthma Hypertension Ischemic stroke |
Altered mental status | Rhino- orbital | L-AmB | Died (21D) | Not done | NA | L-AmB treatment interrupted due to AKI |
| 68/M | Yes | Hypertension Ischemic cardiomyopathy Peripheral arterial disease Morbid obesity |
Ptosis and ophthalmoplegia Blackish discoloration of face |
Rhino- cerebral | L-AmB plus POS plus AFG | Died (13D) | Within 48h | - Culture grew Mucorales - Culture grew CR KP |
- Confirmed by pathology - Course complicated by CR KP meningitis requiring intrathecal Colistin |
| 65/F | New onset with DKA | Hypertension Ischemic heart disease |
- Altered mental status - Blackish discoloration of face |
Rhino- cerebral | L-AmB plus POS plus Anidulafungin | Died (11D) | 5D | NA | CNS involvement with MCA occlusion on admission |
| 72/M | Yes | Ischemic heart disease Chronic Kidney disease | - Bilateral diminution of vision | Rhino- cerebral | AmB then VRC | Died (25D) | Not done | Not done |
- Patient had persistent positive COVID-19 swab that delayed surgery -Course complicated by massive ischemic stroke with central retinal artery occlusion |
| 65/M | Yes | Hypertension | - Left eye swelling and pain - Left facial edema |
Rhino- cerebral | L-AmB | Died (27 D) | Within 48h | - NA | - Received Tocilizumab - Left ICA occlusion with MCA infarction |
| 36/M | New onset | None | Right eye swelling and proptosis | Rhino-orbital | L-AmB | Died (7D) | 4 days | NA | Septic shock following surgery |
| 44/M | New onset with DKA | Lumbar disk prolapse |
Altered mental status Bilateral proptosis |
Rhino-cerebral | AmB | Died (16 D) | Not done | Not done | Course complicated by cavernous sinus thrombosis and MCA occlusion |
AFG: Anidulafungin; AKI: acute kidney injury; AmB: conventional amphotericin B; CAPA: Covid Associated Pulmonary Aspergillosis; CNS: central nervous system; CR KP: Carbapenem resistant Klebsiella pneumonia; D: day; DKA: diabetic ketoacidosis; F: female; GNB: Gram negative bacilli; ICA: internal carotid artery; ITC: itraconazole; L-AmB: liposomal amphotericin B; M: male; MCA: middle cerebral artery; POS: Posaconazole; VRC: voriconazole.