COVID-19–associated rhino-orbital-cerebral mucormycosis: A systematic review, meta-analysis, and meta-regression analysis
Anusuya Bhattacharyya1, Phulen Sarma2, Hardeep Kaur2, Subodh Kumar2, Jaimini Bhattacharyya3, Manisha Prajapat2, Ajay Prakash2, Saurabh Sharma2, Dibbanti Harikrishna Reddy4, Prasad Thota5, Seema Bansal2, Bhaswati Sharma Gautam6, Bikash Medhi2
1 Department of Ophthalmology, Government Medical College and Hospital, sector 32, Chandigarh, India
2 Department of Pharmacology, PGIMER, Chandigarh, India
3 Department of Management Studies, IIT Madras, Chennai, Tamil Nadu, India
4 Department of Pharmacology, Central University of Punjab, Bathinda, Punjab, India
5 Scientist, Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
6 Microbiology, B.P. Civil hospital, Nawgaon, Assam, India
BACKGROUND: Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19–associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases.
MATERIALS AND METHODS: Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. “R-metafor package” was used for analysis.
RESULTS: A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041–0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212–4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205–0.403) despite treatment.
CONCLUSION: Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.
Prof. Bikash Medhi
Department of Pharmacology, PGIMER, Chandigarh
|How to cite this article:|
Bhattacharyya A, Sarma P, Kaur H, Kumar S, Bhattacharyya J, Prajapat M, Prakash A, Sharma S, Reddy DH, Thota P, Bansal S, Gautam BS, Medhi B. COVID-19–associated rhino-orbital-cerebral mucormycosis: A systematic review, meta-analysis, and meta-regression analysis.Indian J Pharmacol 2021;53:499-510
|How to cite this URL:|
Bhattacharyya A, Sarma P, Kaur H, Kumar S, Bhattacharyya J, Prajapat M, Prakash A, Sharma S, Reddy DH, Thota P, Bansal S, Gautam BS, Medhi B. COVID-19–associated rhino-orbital-cerebral mucormycosis: A systematic review, meta-analysis, and meta-regression analysis. Indian J Pharmacol [serial online] 2021 [cited 2022 May 25 ];53:499-510
Available from: https://www.ijp-online.com/article.asp?issn=0253-7613;year=2021;volume=53;issue=6;spage=499;epage=510;aulast=Bhattacharyya;type=0