Acta Scientific Otolaryngology (ASOL) (ISSN: 2582-5550)

Research Article Volume 3 Issue 12

Post-covid Rhino Cerebral Mucor Mycosis: Neurosurgical Experience

Samrendra Kumar Singh1, Brajesh Kumar2* Niraj Kanaujia2 Om Prakash Gupta2, KM Jha3 and Rakesh Kumar Singh4

1Associate Professor, Department of Neurosurgery, IGIMS, Patna, India
2Assistant Professor, Department of Neurosurgery, IGIMS, Patna, India
3Professor and Head of Department, Department of Neurosurgery, IGIMS, Patna, India
4Professor and Head of Department, Department of Otorhinolaryngology, IGIMS, Patna, India

*Corresponding Author: Brajesh Kumar, Assistant Professor, Department of Neurosurgery, IGIMS, Sheikhupura, Raza bazar, Patna, Bihar, India. E-mail: drbrajesh78@gmail.com

Received: September 22, 2021; Published: November 19, 2021

Abstract

Objective: Mucor-mycosis is a fungal infection which usually develops in severe immunocompromised patients, e.g., post-transplant, uncontrolled Diabetes Mellitus, malignancies, and iatrogenic immunosuppression. We faced flood of post-Covid Rhino cerebral Mucor mycosis cases at our institution after second wave of Covid from April to July 2021. We present our experience of ten patients who underwent neurosurgical intervention.

Patients and Methods: This was a prospective study of ten patients who underwent neurosurgical intervention for Rhino cerebral Mucor mycosis. All cases were operated by same surgeons from ENT and Neurosurgery. Disseminated brain abscess, multilobe involvement, brainstem involvement and isolated cavernous sinus thrombosis excluded from this study.

Results: Total forty-five patients referred for neurosurgical opinion, out of those ten patients taken for neurosurgical intervention. Out of ten, nine patients had history of Covid infection (RT-PCR positive). They were treated with steroid and oxygen inhalation. One patient had history of fever, but his Covid RT-PCR was negative. He was treated at home with oxygen. All patients were treated with either liposomal amphotericin B or conventional Amphotericin B depending on the availability and affordability of the patient. Oral Posaconazole (100 mg), six to eight hourly was given to all patients for 6weeks to 3 months in gradual tapering doses depending on the nasal endoscopic findings in the follow up. Sinus surgery was performed in all ten patients by ENT Surgeons, two underwent orbital exenteration by eye surgeon, eight patients underwent open craniotomy for cerebral infection while in two patients’ cerebral exploration done endoscopically. Eight patients survived, while two patients died.

Conclusion: Patients with rhino-cerebral mucormycotic spreading outside the Sino nasal cavity to the base of brain is treatable by early neurosurgical interventions when the abscess cavity is localized to frontal or temporal skull base.

Keywords: Rhino Cerebral; Mucor-mycosis; Post Covid; Immune Suppression

References

  1. Yohai RA., et al. “Survival factors in rhino-orbital-cerebral Mucor mycosis”. Survey of Ophthalmology 39 (1994): 3-22.
  2. Mohindra S., et al. “Rhino cerebral Mucor mycosis: the disease spectrum in 27 patients”. Mycoses 50 (2007): 290-296.
  3. Sundaram C., et al. “Cerebral zygomycosis”. Mycoses 48 (2005): 396-407.
  4. Yeung CK., et al. “Invasive disease due to mucorales: a case report and review of the literature”. Hong Kong Medical Journal 7 (2001): 180-188.
  5. Luna JD., et al. “Intraconal amphotericin B for the treatment of rhino-orbital Mucor mycosis”. Ophthalmic Surgery, Lasers, and Imaging Retina 27 (1996): 706-708.
  6. Blitzer AX., et al. “Patient survival factors in paranasal sinus Mucor mycosis”. Laryngoscope 90 (1980): 635-648.
  7. Peterson KL., et al. “Rhino cerebral Mucor mycosis: evolution of the disease and treatment options”. Laryngoscope 107 (1997): 855-862.
  8. Sims CR and Zeichner LO. “Contemporary treatment and outcomes of zygomycosis in a non-oncologic tertiary care center”. Archives of Medical Research 38 (2007): 90-93.
  9. Gillespie MB., et al. “An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host”. Archives of Otolaryngology-Head and Neck Surgery 124 (1998): 520-526.
  10. Hargrove RN., et al. “Indications for orbital exenteration in Mucor mycosis”. Ophthalmic Plastic and Reconstructive Surgery 22 (2006): 286-291.
  11. Turunc T., et al. “Eleven cases of Mucor mycosis with atypical clinical manifestations in diabetic patients”. Diabetes Research and Clinical Practice 82 (2008): 203-208.
  12. Pillsbury HC and Fischer ND. “Rhino cerebral Mucor mycosis”. Archives of Otolaryngology 103 (1997): 600-604.
  13. Bodenstein NP., et al. “Clinical signs of orbital ischemia in rhino-orbital cerebral Mucor mycosis”. Laryngoscope 103 (1993): 1357-1361.
  14. Talmi YP., et al. “Rhino-orbital and rhino-orbit cerebral mucormycotic”. Otolaryngology-Head and Neck Surgery 127 (2002): 22-31.
  15. Gillespie MB and O’Malley BW. “An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient”. Otolaryngologic Clinics of North America 33 (2000): 323-334.
  16. Gravesen S. “Fungi as a cause of allergic disease”. Allergy 34 (1979): 135-154.
  17. Alleyne CH., et al. “Long term survival of a patient with invasive cranial base rhino cerebral Mucor mycosis treated with combined endovascular, surgical, and medical therapies: case report”. Neurosurgery 45 (1999): 1461-1464.
  18. Ferguson BJ. “Mucor mycosis of the nose and paranasal sinuses”. Otolaryngologic Clinics of North America 3 (2000): 349-365.
  19. Jung SH., et al. “Rhino cerebral Mucor mycosis: consideration of prognostic factors and treatment modality”. Auris Nasus Larynx 36 (2009): 274-279.
  20. Spellberg B., et al. “Novel perspectives on Mucor mycosis: pathophysiology, presentation, and management”. Clinical Microbiology Reviews 18 (2005): 556-569.
  21. Centeno RS., et al. “CT scanning in rhino cerebral Mucor mycosis and aspergillosis”. Radiology 14 (1981): 383-389.
  22. Terk MR., et al. “MR imaging in rhinocerebral and intracranial mucormycosis with CT and pathologic correlation”. Magnetic Resonance Imaging 10 (1992): 81-87.
  23. Weir NW and Golding-Wood DG. “Infective rhinitis and sinusitis”. In: editions. Scott-Brown’s Otolaryngology, 6th Oxford: Butterworth-Heinemann 4.8 (1997): 1-4.
  24. , et al. “Endoscopic sinus surgery in the management of Mucor mycosis”. Journal of Neuro-Ophthalmology 1999 19 (1999): 56-61.
  25. Bonifaz A., et al. “Palatal zygomycosis: experience of 21 cases”. Oral Diseases 14 (2008): 569-574.
  26. Scheckenbach K., et al. “Emerging therapeutic options in fulminant invasive rhino cerebral Mucor mycosis”. Auris Nasus Larynx 37 (2010): 322-328.
  27. Hejny C., et al. “Rhino-orbital Mucor mycosis in a patient with acquired immunodeficiency syndrome (AIDS) and neutropenia”. American Journal of Ophthalmology 132 (2001): 111-112.
  28. Tarani L., et al. “Long-term Posaconazole treatment and follow-up of rhino-orbital-cerebral Mucor mycosis in a diabetic girl”. Pediatric Diabetes 10 (2009): 289-293.
  29. Kohn R and Hepler R. “Management of limited rhino-orbital Mucor mycosis without exenteration”. Ophthalmology 92 (1985): 1440-1404.
  30. Anaissie EJ and Shikhani AH. “Rhino cerebral Mucor mycosis with internal carotid occlusion: report of two cases and review of the literature”. Laryngoscope 95 (1985): 1107-1113.

Citation

Citation: Niraj Kanaujia., et al. “Post-covid Rhino Cerebral Mucor Mycosis: Neurosurgical Experience".Acta Scientific Otolaryngology 3.12 (2021): 17-23.

Copyright

Copyright: © 2021 Niraj Kanaujia. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate34%
Acceptance to publication20-30 days
Impact Factor0.871

Indexed In








News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 25, 2022.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US