Supplementary Table 2.
Details of included studies
| Author, year/country/study design time/duration of study | Study population/sample size (n) | Age group (years) | COVID-19 category/T | Presenting clinical feature/COVID-19 marker at presentation |
|---|---|---|---|---|
| Deepti Satish[1] 2021/India Retrospective study March-December 2020 were included |
Patients with invasive fungal infection n=25 COVID-19 (+) =11 |
30-74 | Asymptomatic: 2 Mild: 2 Moderate: 3 Severe: 4 Concurrent=8 Post-COVID-19=3 |
Unilateral facial swelling, retro-orbital pain, ptosis, and headache |
| Mishra et al.[2] 2021/India Retrospective study August-December 2020 |
COVID-19-associated ROCM patient n=10 |
37-78 | Mild=3 Moderate=6 Severe=1 |
Ocular pain=1 Loss of vision=2 Chemosis=2 Epistaxis=1 Facial pain=1 Headache=1 Ocular swelling=1 Nasal block=2 Nasal crusting=1 |
| Sen et al.[3] 2021/India Retrospective study August-December 2020 |
COVID-19-associated ROCM cases n=6 |
60.5 (range 46.2-73.9) | Moderate-to-severe COVID-19=5 Post-COVID-19 cases=5 Concurrent cases=1 T=30-42 days |
Initial presentation: pain, redness, periocular swelling=6 Developed ptosis, ophthalmoplegia, painful loss of vision average 2 days from day of presentation |
| Sarkar et al.[4] 2021/India Case series October-November 2020 |
A cluster of clinically diagnosed orbital mucormycosis with concurrent COVID-19 illness over 2 months n=10 | 45.5 | Mild-to-moderate: 1 Severe: 9 |
CRAO=6 Loss of vision=4 DKA=4 |
| Moorthy et al.[5] 2021/India Retrospective observational multicenter study May 2020-December 2020 |
Patients with aggressive maxillofacial and ROCM cases concurrent or post COVID-19 positive n=18 |
54.6 (35-73) | No detail Concurrent case=4 Post COVID-19=14 |
Loss of vision=12/18 maxillary sinusitis=18/18 Maxillary necrosis=14/18 Intracranial extension=9/18 |
| Sharma et al.[6] 2021/India Prospective observational study August-December 2020 |
Mucormycosis of PNS with history of COVID-19 n=23 |
NA | NA Concurrent COVID-19 infection: 4 Post COVID-19 mucormycosis: 14 |
Intraorbital extension=43.47% Intracranial extension=8.69% Involvement of ethmoid sinus=100% Classical black escher on hard palate=9/23 |
| Nehara et al.[7] 2021/India Case series November-December 2020 |
COVID-19-associated ROM patient n=5 |
62.2 | Severe to critical=2 Mild-to-moderate=3 Concurrent COVID-19=3 Post COVID-19=2 |
Loss of vision=3 Headache=3 Ptosis=2 Proptosis=4 Palate inv=3 Complete ophthalmoplegia=2 Epistaxis=3 |
| Ravani et al.[8] 2021/India Retrospective study September 2020-mid-March 2021 |
All biopsy-proven mucormycosis patient Total n=31 COVID-19=19 All are post-COVID, no case of concurrent COVID-19 |
56.3 | NA T=average 2 months No concurrent COVID-19 case |
Commonest presentation: Diminution of vision (<6/60 in 80.64%), ophthalmoplegia (77.4%) |
| Diwakar et al., 2021[9]/India Case series Preprint |
CAM patient of pediatric age group with type 1 DM n=2 |
Case 1=11 Case 2=13 |
Asymptomatic COVID-19 infection ROCM developed during course of DKA T=3 days (case 1) T=20 (case 2) |
Case 1: Weight loss, unilateral pain and swelling of eye, high-grade fever, complete ophthalmoplegia Case 2: Unilateral pain, swelling and diplopia, complete ophthalmoplegia, nonreactive pupil |
| Gangneux et al., 2021[10]/French National multicenter observational study 18 French ICU Preprint February 29 and July 9, 2020 |
Severe COVID-19 population with IFI≥18 years age group n=57 |
59.4±12.5 | Severe COVID-19=57 | Mucormycosis prevalence 1.2% |
| Buil et al., 2021[11]/Netherlands Case series |
Secondary fungal infections caused by Mucorales species in COVID-19 patients n=4 |
>50 | 3 CAM cases occurred in ICU one outside ICU | Pulmonary, rhino-orbital cerebral and disseminated infection |
| Fouad et al., 2021[12]/Egypt Retrospective observational study March 25, 2020-September 25 |
ROCM patients n=12 COVID-19 positive=6 Concurrent case=5 Post-COVID-19 positive=1 |
51.2 (16.7) | Moderate-to-severe=5 | Orbital invasion=all Cerebral invasion=8 Lid edema(50%), conjunctival chemosis (50%) diminution of vision (41.7%), proptosis (33.3%), facial edema (25%), nasal Crusts (25%), total ophthalmoplegia (16.7%) Paralytic esotropia (8.3%) |
| El-Kholy et al., 2021[13]/Egypt/longitudinal prospective study August 2020-December 2020 |
COVID-19-associated acute invasive fungal rhino sinusitis n=36 |
52.92±11.30 | Mild=11 Moderate=13 Severe=12 MV needed=3 |
Headache and facial pain (75%) Facial numbness (66.7%) Ophthalmoplegia, and visual Loss (63.9%) Proptosis=19 Diplopia=6 Palatal involvement=11.1% Necrosis of cheek=1 Orbital apex syndrome=3 |
| Wael F. Ismaiel et al., 2021[14]/Egypt/retrospective study January 2017-December 2020 |
Diagnosed AIFRS n=56 Total post COVID-19 cases=18 |
58.38±12.2 | ARDS=3 | - |
| Manar M. Ashour, et al., 2021[15] Case series May 2020-February 2021 |
Confirmed COVID-19 AIFS n=7 |
- | T=12-35 days | Right upper eyelid edema=4 Total ophthalmoplegia=5 No PL=5, black nasal crusts=6 Rapidly deteriorating visual acuity=1 Conjunctival chemosis=1 Proptosis=1 Paralytic esotropia=1 Bilateral oroantral fistulae=1 Eyelid edema=1 Reduced visual acquity=1 Facial edema=2 Skin discoloration=1 bilateral Panophthalmitis=1, necrosed nasal septum=1Nacrosed hard palate=1 Painful orbital proptosis=1 Drop of vision=1 Panophthalmitis=1 Septal ulceration=1 Panophthalmitis=4 Orbital compartment syndrome=1 Optic nerve ischemia/inflammation=2 Bilateral orbital panophthalmitis=2 Intracranial complications were: Perineural spread=6 Cavernous sinus involvement=6 Meningeal/epidural infiltration=3 ICA vasculitis/thrombosis=4 ICA mycotic aneurysm=intracerebral Abscess=2 and cerebral infarctions=3 |
| Ricardo Rabagliati et al.[16]/2021/Santiago, Chile Retrospective case series During May 18-July 18, 2020 |
Nonimmunocompromised adult CAIMI cases with severe COVID-19 cases admitted in ICU Total severe to critical COVID-19 cases=146 n=16 |
Median age65 (30-89) | All severe to critical COVID-19 cases T=18.5 (range 1-47) days 14.5 days (range 0-28) After ICU admission 12.5 days (range 0-28) after IMV |
- |
| Bayram et al., 2021[17]/prospective observational study March 2020-December 2020 |
COVID-19-associated ROM cases in severe COVID-19 patients n=11 |
- | All severe COVID-19 cases T=5.1±1.8 days (2-8 days) Increased D-dimer=all patient Low molecular weight heparin received=all mean D-dimer level=1362.4±468.9 μg/L |
Proptosis (100%) Ophthalmoplegia (63.6%), orbital pain (81.8%), conjunctival Hyperemia/chemosis (81.8%), ptosis (63.6%), fixed and dilated pupil (63.6%), vision loss (63.6%), endophthalmitis (54.5%), decreased vision (27.3%), orbital apex syndrome 7 (63.3%) syndrome, orbital cellulitis (36.4%) |
| Joshi et al., 2021[18]/India/retrospective study March 1, 2021-April 15, 2021 | COVID-19 and invasive ROCM cases | 55.2±13, range 34-76 | Severe to critical COVID-19 | - |
| Atul Patel et al., 2021[19]/India/multicenter retrospective study in 16 healthcare centers across India September-December 2020 |
Confirmed mucormycosis cases with and without COVID-19 Total mucormycosis patient=287 CAM=187 (65.2%) |
53.4 (SD 17.1) | T=median time 18 days (IQR 11-27) | Commonest is rhino-orbital mucormycosis (58.2%), followed by ROCM, pulmonary and other sites |
| Muley et al., 2021[20]/India/observational study April 15, 2021, and May 15, 2021 Preprint |
Probable RMMn=30 | - | 23 (76.6%) gave a history of hospitalization due to COVID-19 17 (23.3%) had no history of hospitalization |
6.6% of cases were in Grade 1, while 53.5% were in Grade 2, and 40% were in Grade 3 |
| Farzad Pakdel et al., 2021[21]/Iran/cross-sectional descriptive multicenter study in five COVID-19 hospitalized centers in Tehran, Iran April-September 2020 |
Biopsy-proven ROCM patients with COVID-19 n=15 |
52 (range 14-71) | Mild=3 Moderate=5 Severe=7 T: 1-37 days |
Unilateral periorbital pain and edema (73%), ptosis (73%), acute vision loss (73%), proptosis (67%), unilateral facial edema (60%), cranial nerve palsy (60%), headache (33%), fever (27%), nasal blockage (13%) and ear pain (7%) |
| Rajalakshmi Arjun et al., 2021[22]/India/case series | COVID-19-associated rhino-orbital mucormycosis n=10 |
53.0±12.1 | All cases had past H/O COVID-19 T=17.0±3.6 days |
Headache=6 Facial swelling=3 Facial numbness=1 Lid swelling=4 Black discoloration of palate=1 Ocular pain=3 Earache=1 Diplopia=1 Sphenoid=8 Intracranial spread=3 Optic nerve involvement=2 |
| Sebastian et al., 2021[23]/India/case series | CAIFS n=3 |
61±2.64 | Severe to critical=3 Bilateral COVID-19 pneumonia with ARDS=3 Altered sensorium=1 RF and shock=1 |
Nasal blockage=1 facial swelling=1 Periorbital swelling=2 Blackening of middle turbinate=2 Blackening of the lateral wall of nose with crusts and discharge=1 Thick dirty nasal discharge=1 Eye pain=1 Restricted eye movements=1 Diminution of vision=1 Cavernous sinus thrombosis=1 Proptosis=1 Periorbital bluish discoloration=1 |
|
| ||||
| Author, year/country/study design time/duration of study | Co-morbidities/risk factor | Hyperglycemia at presentation | Treatment | Comment |
|
| ||||
| Deepti Satish[1] 2021/India Retrospective study March-December 2020 were included |
Immunocompromised-23 Immunocompetent=2 Majority of the patients with DM and HTN with underlying IHD and CKD Leukemia=1 |
CAM cases had HbA1c level 7-15 mg/dl (majority >10 mg/dl) COVID-19 negative Mucor patients had HbA1c level 6-13 mg/dl (majority <10 mg/dl) |
Empirical IV Amph B in severe CAM patients and debridement done once stable COVID-negative cases: Debridement followed by IV AmphB IV AmphB dose: 50 mg/kg/day with cumulative dose of 1.5-2 g Postoperatively local diluted AmphB douching all cases Debridement: 20 |
Details of COVID-19 patient profile is not available Redebridement done in 1 patient after 1 month due to vision loss Significant delay in the surgical management of moderate-to-severe COVID-19 patients were there due to lack of fitness for GA |
| Mishra et al.[2] 2021/India Retrospective study August-December 2020 |
DM=8 HTN=3 CKD=2 CLD=1 IHD=1 Hypothyroidism=2 |
No detail available | Steroid=6 Amph B=10 Posaconazole=1 RDV=6 Tocilizumab=1 |
4/10 patients were diagnosed and managed for COVID-19 6/10 were treated for COVID-19 outside Lost to follow-up=1 |
| Sen et al.[3] 2021/India Retrospective study August-December 2020 |
DM (Type 2): 100%2/6 were diagnosed of DM with the onset of COVID-19 | Average FBS=222.5±144.4 (86-404) mg/dL at presentation Mean duration of DM=5.9±4.9 (median 6.5) years Uncontrolled DM=5 DKA=3 Case 2: Moderate NPDR with DME |
Antifungals started after microbiological confirmation LipAmpB B (5 mg/kg/day, up to a maximum of 10 mg/kg/day I.V. for CNS infections) Oral posaconazole (loading dose 300 mg BD day 1 followed by maintenance dose 300 mg OD) Orbital-exenteration: In suboptimal response to systemic antifungals within 72 h |
Male cases 100% All were referred cases |
| Sarkar et al.[4] 2021/India Case seriesOctober-November 2020 |
DM: 10/10 (100%) Steroid: 10/10 (100%) |
DKA at admission: 4/10 DKA during COVID-19 therapy: 5/10 |
All patient received dexamethasone as per NIH guideline LipAmpB: All cases RDV=4/10 Ventilatory support=9/10 |
Detail dose not given |
| Moorthy et al.[5] 2021/India Retrospective observational multicenter study May 2020-December 2020 |
DM: 16/18 | All poorly controlled DM | Mucormycosis: LipAmpB at 3-5 mg/kg to a cumulative dose of 3-5 g Aspergillosis: Oral voriconazole (6 mg/kg IV 12 hourly Day 1/4 mg/kg IV 12 hourly subsequently) and posaconazole (200 mg) Orbital exenteration: 7 Maxillectomy: 11 Endoscopic sinus surgery: 17 |
Maxillary necrosis=14/18, which is statistically significant (P=0.03) Lost to follow up=1 |
| Sharma et al.[6] 2021/India Prospective observational study August-December 2020 |
DM: 21 HTN: 14 Renal failure: 1 Steroid user=100% |
DM: 21 Uncontrolled DM: 12 (HbA1c>6.5%) |
Intra-orbital AmpB: 2 | None gave consent for orbital exenteration Mortality: 0% |
| Nehara et al.[7] 2021/India Case series November-December 2020 |
DM: 5 HTN: 2 |
Uncontrolled DM=3 DKA=1 Ketosis without acidosis=1 |
LipAmpB=all Posaconazole=1 MV=1 Broad-spectrum antibiotics=all Ionotrops=2 |
- |
| Ravani et al.[8] 2021/India Retrospective study September 2020-mid-March 2021 |
COVID-19 positivity: 61.2% Uncontrolled DM: 96.7% Steroid user: 61.2% HTN=54.8% IHD=3.22% Kidney disease=6.45% |
Uncontrolled type 2 DM=29 (93.54%) Uncontrolled type I DM=1 Newly diagnosed DM=6 Average duration of DM=4.4 years Average HBA1C=7.57 mmol/mol Duration of steroid=7-14 days |
IV LipAmpB B: 31 (100%) after microbiological confirmation Sinus debridement: 31 (100%) Exenteration: 4 (12.9%) IV LipAmpB dose=3-5 mg/kg body weight/day Oral posaconazole: Add-on therapy at time of resolution (5 mg/kg body weight/day) |
Cerebral involvement and HbA1c ≥8 found to be significant in prediction of 75-day mortality (P≤0.05) |
| Diwakar et al., 2021[9]/India Case seriesPreprint |
Type 1 DMNO H/O Steroid exposure |
Both are cases pf type 1 DM | I.V. LipAmpB=2 Retro orbital AmpB=2 Craniotomy (for brain abscess)=2 Orbital exenteration with resection of the involved sinuses. =2 I.V LipAmpB dose (10 mg/kg/day) in 5% dextrose over 1 h for 6 weeks |
Case 1: hypokalemia (serum K+=2.8 mmol/L), hyperglycemia 96 (RBS=329 mg/dL Case 2: LFT: Hypoalbuminaemia 130 (3 g/dL) and low albumin/globulin ratio (1.00) |
| Gangneux et al., 2021[10]/French National multicenter observational study 18 French ICU Preprint February 29 and July 9, 2020 |
DM: 32·9% HTN: 50·1% Lymphopenia at presentation: 64·2% Mean duration of MV: 27·1±19·8 days |
- | Detail for mucormycosis patients not available | Detail profile of for mucormycosis patients not available |
| Buil et al., 2021[11]/Netherlands Case series |
DM=2 Steroid=4 MV=4 CLL=1 Obesity=1 |
DM=2 Uncontrolled DM=1 |
Tocilizumab=1 LAmpB=4 Prosaconazole=1 Voriconazole=1 Isavuconazole=2 INF Gama=1 |
Microscopy showed nonseptate hyphae in the patient’s urine in 1 case died 3 out of 4 cases |
| Fouad et al., 2021[12]/Egypt Retrospective observational study March 25, 2020-September 25 |
DM=10 Hematological malignancy=2 received chemotherapy CKD=3 IHD=1 |
DM=10 Uncontrolled DM=10/12 cases (83.3%) Occurrence of DM at time of ROCM diagnosis=9 Median HbA1c=9.7% DKA=1 |
Debridement done=7 (58.3%) | - |
| El-Kholy et al., 2021[13]/Egypt/longitudinal prospective study August 2020-December 2020 |
DM (27.8%) HTN (16.67%) Associated malignancy, uncontrolled leukemia, and pancreatic cancer=5.56% |
DM=10 (27.8%) 3/10 COVID-19-associated due to corticosteroid therapy |
Antifungal therapy and surgery=34 Only antifungal therapy=2 LipAmpB=26 Voriconazole=8 Both=2 Posaconazole=3 |
Individual data for COVID-19-associated mucormycosis not given Early cases (n=7) with limited sinonasal involvement showed better results |
| Wael F. Ismaiel et al., 2021[14]/Egypt/retrospective study January 2017-December 2020 |
DM=44.4% of post-COVID-19 AIFRS Immunosuppressive=16.7% HTN=10 obesity=8 Smoking=12 Allergic rhinitis=14 Asthma=4 COBD and Cardiac diseases=5 Otitis media=6 Renal dysfunction=3 Liver dysfunction=2 Thrombocytopenia and leucopenia=4 Immunosuppressive drugs=3 Antibiotic or antiviral therapy=12 Steroid use=7 Chemotherapy=1 |
DM=44.4% of post-COVID-19 AIFRS | - | Incidence of AIFRS is more prominent in post-COVID-19 patients than in non-COVID-19 especially in immunocompromised patients, diabetic, renal and liver dysfunction patients and patients with risk factors for rhino sinusitis |
| Manar M. Ashour, et al., 2021[15] Case series May 2020-February 2021 |
DM (n=6), HTN (n=2), end stage renal disease (n=2), hyperlipidemia (n=2), ischemic heart disease (n=1), previous cerebral stroke (n=1) | - | AmpB=7 Itraconazole=1 Ambisome=1 Surgical debridement=7 |
Patients had radiologic features of aggressive late-stage forms of the disease process with a consequent long-term morbidity rate of 100% and a high mortality rate of 37.5% |
| Ricardo Rabagliati et al.[16]/2021/Santiago, Chile Retrospective case series During May 18-July 18, 2020 |
HTN=9 (56.3%) Asthma/COPD=4 (25%) DM=4 (25%) Obesity=3 (18.8%) Median worst PaO2/FiO2 for each patient was 124 (range 57-476) None were immunocompromised |
- | Antifungal therapy=13 (81.3%) Voriconazole=10 (76.9%) LipAmpB=2 (15.4%) Isavuconazole=1 (7.7%) Therapeutic drug monitoring received with patients under voriconazole therapy=9 patients receiving (median 3.9 mg/L; range 0.1-7.2 mg/L) |
Severe hypoxia, broad-spectrum Antibiotics, high corticosteroid doses, prolonged ICU stay, long intubation period, and airway/lung damage and infarction areas are predisposing condition for critically ill patients |
| Bayram et al., 2021[17]/prospective observational study March 2020-December 2020 |
COVID-19-associated ARDS=11 Corticosteroid=11 DM=8 (72.7%) CRF=3 ARF=2 Hematological malignancy=1 under immunosuppressive |
Type 2 DM=8 (72.7%), all uncontrolled Mean duration of diagnosis=12.1±4.4 years (range: 7-19 years) |
IV and retro bulbar LipAmpB=all cases Intravitreal LipAmpB in patients with endophthalmitis IV dose=1.0 mg/kg/day, increasing a total dose of 2.5-3 g Retro bulbar dose=1 ml of 3.5 mg/ml Intravitreal dose=5 μg/0.1 ml Second surgical procedure=8 (72.7%) Mean number of retrobulbar and intravitreal AmpB injections=2.2±0.6 and 2.3±0.5 Interval between repeat injections varied from 2-8 days |
Diagnosis of mucormycosis was made in all patients during the COVID-19 treatment The mean MIC of amphotericin B was 2.5±1.0 μg/ml (range: 1.5-4 μg/ml) The MIC of voriconazole was >32 μg/ml in all patients All endophthalmitis cases showed posterior scleritis, two developed retinochoroiditis followed by retinoschisis, and one had corneal edema |
| Joshi et al., 2021[18]/India/retrospective study March 1, 2021-April 15, 2021 |
DM=22 Uncontrolled DM=13 HIV=2 MV received=2 Corticosteroids=2 (duration, 10-14 days) |
- | Amphotericin B=all Surgical debridement=10 Orbital exenteration=10 s |
- |
| Atul Patel et al., 2021[19]/India/multicenter retrospective study in 16 healthcare centers across India September-December 2020 |
COVID-19 only 61 (32.6%) Glucocorticoids 48/61 (78.7) DM=113 (60.4%) Posttrauma=3 (1.6%) Hematological malignancy=2 (1.1%) Renal transplantation=3 (1.6%) Median cumulative Dexamethasone-equivalent dose=84 mg (range 18-1,343 mg) Tocilizumab=5 (2.7%) Hypoxemia due to COVID-19 and inappropriate glucocorticoid administration were associated with development of late CAM |
Uncontrolled DM=62.7% DKA=early (28%), late CAM (5%) Newly diagnosed DM=39/187 (20.9%) COVID-19 was the only underlying disease in 61/187 (32.6%) |
LipAmp B=136 (72.7%) AmpD deoxycholate=31 (16.6%) Posaconazole=73 (39.0%) Isavuconazole=19 (10.2%) Single antifungal drug=95 (50.8%) Concurrent=13 (7.0%) Sequential=79 (42.5%) Combined medical and surgical therapy=131 (70.1%) LipAmpB dose=5 mg/kg 1×/d for 4-6 weeks AmpB deoxycholate=1 mg/kg 1×/d for 6-8 week Sequential antifungal drug treatment improved mucormycosis survival |
CAM prevalence=0.27% among hospitalized COVID-19 patients Newly diagnosed DM in CAM patients were significantly higher (P=0.02) DKA seen more in non-CAM patients (16/187 [8.6%]) than in CAM patients (27/100 [27%]; P=0.0001) COVID-19-related hypoxemia and improper glucocorticoid use independently were associated with CAM |
| Muley et al., 2021[20]/India/observational study April 15, 2021, and May 15, 2021 Preprint |
76.66% had a history of COVID-19, and 66.66% had hospitalization and steroid administration history | 84% patients had diabetes mellitus | 36% were operated on by OMFS, and 6.6% were referred to an ENT specialist | - |
| Farzad Pakdel et al., 2021[21]/Iran/cross-sectional descriptive multicenter study in five COVID-19 hospitalized centers in Tehran, Iran April-September 2020 |
DM=13 (86%) HTN=7 (46%) Hematologic malignancies=2 (13%), Asthma 2 (13%) Cardiovascular disease 2 (13%), hepatic cirrhosis 1 (6%), hypothyroidism 1 (6%), TB 1 (6%), immunosuppressive therapy 7 (46%), chemotherapy 2 (13%), neutropenia 3 (20%), ketoacidosis 1 (6%) |
46.6% patients previously received intravenous corticosteroid therapy | IV AmpB: All cases Oral posaconazole: 4 (27%) Combined anti-fungal therapy: 6 (40%) IV AmpB (5 mg/kg daily for 4-6 weeks) Orbital exenteration=5 Palatal debridement=2 |
Anti-fungal combination therapy was significantly associated with Better outcome (P=0.003) |
| Rajalakshmi Arjun et al., 2021[22]/India/case series | DM=all HTN=2 Hypothyroidism=1 CAD=3 CKD=1 RA=1 Supplemental O2 required=8 Steroid therapy=8 Broad-spectrum IV antibiotics=9 Steam inhalation: 9 |
DM=all cases Mean HbA1c: 10.2±2.0 |
Endoscopic sinus surgery and debridement was done in all patients within 24 h Antifungals used included liposomal amphotericin B Amphotericin B deoxycholate and isavuconazole |
- |
| Sebastian et al., 2021[23]/India/case series | DM=1 CABG=1 CKD=1 HTN=1 MV=2 (Case 1=on mechanical ventilation for 7 days) Peptic ulcer=1 BSA=3 Steroid=3 Renal replacement therapy=2 |
All three are diabetic controlled | Case 1=liposomal amphotericin B was given (total dose of 3050 mg). Subsequently he was continued on voriconazole Surgical debridement was done Case 2=total dose of 850 mg of liposomal amphotericin B |
Case 1: Although clinical resolution was seen, during the post-COVID recovery phase patient developed myocarditis with cardiac arrhythmia and expired Case 2=surgical debridement could not be carried Case 3=developed massive peptic ulcer bleed and went into irreversible shock and died |
MV=Mechanical ventilation, IMV=Invasive mechanical ventilation, ARDS=Acute respiratory distress syndrome, ROCM=Rhino-orbito-cerebral mucormycosis, CAM=COVID-19 associated mucormycosis, T=Time to develop mucormycosis from COVID-19 diagnosis, IHD=Ischemic heart disease, CKD=Chronic kidney disease, RDV=Remdesivir, FBS=Fasting blood sugar level, DKA=Diabetic ketoacidosis, NPDR=Nonproliferative diabetes mellitus, DME=Diabetic macular edema, CRAO=Central retinal arterial occlusion, PNS=Paranasal sinus, BSA=Broad spectrum IV antibiotics, AIFRS=Acute invasive fungal rhino sinusitis, RMM=Rhinomaxillary mucormycosis, ICU=Intensive care unit, OMFS=Oral and maxillofacial surgeons, PL=Perception of light, IFI=Invasive fungal infections, SD=Standard deviation, IQR=Interquartile range, NA=Not available, DM=Diabetes mellitus, HTN=Hypertension, ARF=Acute renal failure, COPD=Chronic obstructive pulmonary disease, CRF=Chronic respiratory failure, CABG=Coronary artery bypass grafting, HbA1c=Hemoglobin A1c, RBC=Red blood cell, MIC= Minimal inhibitory concentration, LFT= Liver function test, NIH=National institute of health, ENT= Ear nose and throat, ICA= Internal carotid artery RF=Respiratory failure, TB= Tuberculosis, RA= Rheumatoid arthritis, GA= General anaesthesia, ROM=Rhino orbital mucormycosis, AIFS= Acute invasive fungal sinusitis, CAIMI=Covid-19 associated invasive mucorales infection