DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20214898

Central nervous system manifestations of mucormycosis

Ishita A. Shah, Niral R. Modi

Abstract


Background: There has been an unprecedented increase in the number of mucormycosis cases post the second wave of COVID-19 in India, with a variety of clinical manifestations. The central nervous system manifestations have proven to be especially fatal, hence these require special attention. Aims and objectives of current investigation was to study the epidemiology, clinical features, risk factors, diagnostic modalities, management and complications of CNS manifestations of mucormycosis.

Methods: This is a retrospective study, conducted on the mucormycosis patients admitted in G.G. hospital Jamnagar. Patients with clinically and radiologically evident central nervous system involvement were included in the study. The records of the patients were followed for 3 months post the diagnosis. 47 patients were included in the study.

Results: The mean age of the patients was 51 years. 72.34% of patients were males, and 27.65%, were females. The most common clinical feature was headache 100% followed by fever 55%. Most of the patients (97.87%) had history of COVID 19 or had active infection. 63.96% had diabetes Mellitus. The most common radiological finding was cavernous sinus thrombosis (32.60%), 72.34% underwent surgical debridement, and all the patients were administered Amphotericin B. The outcome improved significantly with surgical debridement, with recovery seen in 51.06% patients.

Conclusions: There has been a steep rise in the cases of mucormycosis following the COVID-19 pandemic. It is an extremely virulent infection which spreads rapidly, often causing the involvement of the central nervous system. However, early diagnosis and intervention have been found to alter the prognosis significantly.


Keywords


Mucormycosis, Amphotericin B, Central nervous system

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References


Raut A, Huy NT. Rising incidence of mucormycosis in patients with COVID-19: another challenge for India amidst the second wave? Lancet Respir Med. 2021;9(8):e77.

Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. J Fungi. 2019;5(1):26.

Hosseini SM, Borghei P. Rhinocerebral mucormycosis: pathways of spread. Eur Arch Otorhinolaryngol. 2005;262(11):932-8.

Bala K, Chander J, Handa U, Punia RS, Attri AK. A prospective study of mucormycosis in north India: experience from a tertiary care hospital. Med Mycol. 2015;53(3):248-57.

Ho KL. Acute subdural hematoma and intracerebral hemorrhage. Rare complications of rhinocerebral mucormycosis. Arch Otolaryngol. 1979;105(5):279-81.

Sasannejad P, Ghabeli-Juibary A, Aminzadeh S, Olfati N. Cerebellar infarction and aneurysmal subarachnoid hemorrhage: An unusual presentation and rare complications of rhinocerebral mucormycosis. Iran J Neurol. 2015;14(4):222-4.

Mutsukura K, Tsuboi Y, Imamura A, Fujiki F, Yamada T. Garcin syndrome in a patient with rhinocerebral mucormycosis. No To Shinkei. 2004; 56(3):231-5.

Nam SH, Chung YS, Choi YJ, Lee JH, Kim JH. Treatment outcomes in acute invasive fungal rhinosinusitis extending to the extrasinonasal area. Sci Rep. 2020;10(1):3688.

Ramadorai A, Ravi P, Narayanan V. Rhinocerebral Mucormycosis: A Prospective Analysis of an Effective Treatment Protocol. Ann Maxillofac Surg. 2019;9(1):192-6.

Arora K, Mehta A, Virk RS, Saini M. Cerebrospinal fluid leak from lateral orbit during exenteration for mucormycosis. BMJ Case Rep. 2020;13(9):e237575.

Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus. 2020;12(9): e10726.

El-Herte RI, Baban TA,. Kanj SS. Mucormycosis: A review on environmental fungal spores and seasonal variation of human disease. Adv Infect Dis. 2012; 2(3):76-81.