Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort study
Background: Rhino cerebral mucormycosis is an uncommon opportunistic infection of the nasal sinuses and brain, and a group of saprophytic fungi causes it. During the second wave of COVID-19, India witnessed an unprecedented number of patients with rhino cerebral mucormycosis. Invasion of the caverno...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-11-01
|
| Series: | Journal of Infection and Public Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034122002623 |
| _version_ | 1811344541601497088 |
|---|---|
| author | Shweta Pandey Hardeep Singh Malhotra Ravindra Kumar Garg Kamini Sharma Imran Rizvi Sukriti Kumar Neeraj Kumar Ravi Uniyal Praveen Kumar Sharma Prashant Gupta Amita Jain D. Himanshu Reddy |
| author_facet | Shweta Pandey Hardeep Singh Malhotra Ravindra Kumar Garg Kamini Sharma Imran Rizvi Sukriti Kumar Neeraj Kumar Ravi Uniyal Praveen Kumar Sharma Prashant Gupta Amita Jain D. Himanshu Reddy |
| author_sort | Shweta Pandey |
| collection | DOAJ |
| description | Background: Rhino cerebral mucormycosis is an uncommon opportunistic infection of the nasal sinuses and brain, and a group of saprophytic fungi causes it. During the second wave of COVID-19, India witnessed an unprecedented number of patients with rhino cerebral mucormycosis. Invasion of the cavernous sinus and occlusion of the internal carotid artery in many cases resulted in a stroke. The study aimed to assess the clinical and neuroimaging predictors of stroke in patients with rhino cerebral mucormycosis. We also evaluated the predictors of death in these patients at 90 days. Methods: A prospective study was performed at a tertiary care centre in India between July 2021 and September 2021. We enrolled consecutive microbiologically confirmed patients of rhino cerebral mucormycosis. All patients underwent neuroimaging of the brain. Treatment comprised of anti-fungal drugs and endoscopic nasal/sinus debridement. We followed the patients for 90 days and assessed the predictors of stroke and mortality Results: Forty-four patients with rhino cerebral mucormycosis were enrolled. At inclusion, in 24 patients, the RT-PCR test for SARS-COV-2 was negative. Diabetes mellitus was the most frequent (72.7 %) underlying risk factor; in most, diabetes mellitus was recently discovered. At inclusion or subsequent follow-up, stroke was seen in 11 (25 %) patients. Only seven patients had hemiparesis. Imaging revealed internal carotid artery occlusion in 17 (38.6 %) patients. Hypertension, corticosteroid use, and cavernous sinus thrombosis were independent predictors of stroke. Nine (20.5 %) died during follow-up, and stroke was an independent predictor of death. Conclusion: Stroke indicated poor prognosis among rhino cerebral mucormycosis patients encountered during the second wave of the COVID-19 epidemic. |
| first_indexed | 2024-04-13T19:49:39Z |
| format | Article |
| id | doaj.art-f07f1c724b1042c6aef866652929051b |
| institution | Directory Open Access Journal |
| issn | 1876-0341 |
| language | English |
| last_indexed | 2024-04-13T19:49:39Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj.art-f07f1c724b1042c6aef866652929051b2022-12-22T02:32:37ZengElsevierJournal of Infection and Public Health1876-03412022-11-01151112651269Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort studyShweta Pandey0Hardeep Singh Malhotra1Ravindra Kumar Garg2Kamini Sharma3Imran Rizvi4Sukriti Kumar5Neeraj Kumar6Ravi Uniyal7Praveen Kumar Sharma8Prashant Gupta9Amita Jain10D. Himanshu Reddy11Department of neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India; Corresponding author.Department of neurology, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of neurology, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of neurology, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of neurology, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of Radiodiagnosis, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of neurology, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of neurology, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of neurology, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaDepartment of Internal Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, IndiaBackground: Rhino cerebral mucormycosis is an uncommon opportunistic infection of the nasal sinuses and brain, and a group of saprophytic fungi causes it. During the second wave of COVID-19, India witnessed an unprecedented number of patients with rhino cerebral mucormycosis. Invasion of the cavernous sinus and occlusion of the internal carotid artery in many cases resulted in a stroke. The study aimed to assess the clinical and neuroimaging predictors of stroke in patients with rhino cerebral mucormycosis. We also evaluated the predictors of death in these patients at 90 days. Methods: A prospective study was performed at a tertiary care centre in India between July 2021 and September 2021. We enrolled consecutive microbiologically confirmed patients of rhino cerebral mucormycosis. All patients underwent neuroimaging of the brain. Treatment comprised of anti-fungal drugs and endoscopic nasal/sinus debridement. We followed the patients for 90 days and assessed the predictors of stroke and mortality Results: Forty-four patients with rhino cerebral mucormycosis were enrolled. At inclusion, in 24 patients, the RT-PCR test for SARS-COV-2 was negative. Diabetes mellitus was the most frequent (72.7 %) underlying risk factor; in most, diabetes mellitus was recently discovered. At inclusion or subsequent follow-up, stroke was seen in 11 (25 %) patients. Only seven patients had hemiparesis. Imaging revealed internal carotid artery occlusion in 17 (38.6 %) patients. Hypertension, corticosteroid use, and cavernous sinus thrombosis were independent predictors of stroke. Nine (20.5 %) died during follow-up, and stroke was an independent predictor of death. Conclusion: Stroke indicated poor prognosis among rhino cerebral mucormycosis patients encountered during the second wave of the COVID-19 epidemic.http://www.sciencedirect.com/science/article/pii/S1876034122002623SARS-COV-2MucormycosisStroke |
| spellingShingle | Shweta Pandey Hardeep Singh Malhotra Ravindra Kumar Garg Kamini Sharma Imran Rizvi Sukriti Kumar Neeraj Kumar Ravi Uniyal Praveen Kumar Sharma Prashant Gupta Amita Jain D. Himanshu Reddy Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort study Journal of Infection and Public Health SARS-COV-2 Mucormycosis Stroke |
| title | Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort study |
| title_full | Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort study |
| title_fullStr | Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort study |
| title_full_unstemmed | Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort study |
| title_short | Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort study |
| title_sort | determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of covid 19 pandemic a prospective cohort study |
| topic | SARS-COV-2 Mucormycosis Stroke |
| url | http://www.sciencedirect.com/science/article/pii/S1876034122002623 |
| work_keys_str_mv | AT shwetapandey determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT hardeepsinghmalhotra determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT ravindrakumargarg determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT kaminisharma determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT imranrizvi determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT sukritikumar determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT neerajkumar determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT raviuniyal determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT praveenkumarsharma determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT prashantgupta determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT amitajain determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy AT dhimanshureddy determinantsofstrokeinpatientswithrhinocerebralmucormycosisseenduringthesecondwaveofcovid19pandemicaprospectivecohortstudy |