Abstract

COVID-19-associated mucormycosis is a severe, life-threatening, invasive fungal infection whose incidence was increased substantially in Pakistan during the COVID-19 pandemic. Several studies have described its management, but limited data are available in Pakistan. We assessed the risk factors, treatment modalities, and prognosis of CAM-ROCM to help healthcare providers better manage the disease. A cross-sectional comparative study was conducted to explore demographics, risk factors, clinical manifestations, laboratory parameters, and treatment outcomes of COVID-19-associated rhino-orbital cerebral mucormycosis. A total of 72 patients were included in the study, comprising 41 patients with confirmed COVID-19-associated rhino-orbital cerebral mucormycosis. Most patients were male, aged 40-60 years, and residents of rural areas with diabetes and corticosteroid consumption. Among the stages, rhino-orbital cerebral mucormycosis (41.5%) was the most prevalent, followed by sino-orbital (29.2%), sino-cerebral (17.1%), and rhino-sino mucormycosis (12.2%). Common clinical symptoms included black-brownish nasal discharge, unilateral facial pain, swelling, malaise, fever, eyelid edema, and ophthalmalgia. Most of the patients (82.9%) received amphotericin B deoxycholate. After one week of therapy, blood urea and creatinine levels were elevated, while hypokalemia was observed. A total of 18 patients died, while Hb1Ac, hospital stay duration, steroid therapy, mucormycosis type, and blood urea, creatinine, and potassium levels were significant predictors of survival. Diabetic patients consuming corticosteroids are vulnerable to COVID-19-associated mucormycosis. An uninterrupted supply of liposomal amphotericin B is crucial, and patients receiving therapy should also be observed for the signs of nephrotoxicity.

Key words: COVID-19; mucormycosis; rhino-orbital cerebral mucormycosis; diabetes; corticosteroids