WORLD JOURNAL OF PLASTIC SURGERY
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Volume 14, Issue 2 (2025)
WJPS 2025, 14(2): 79-85 |
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Kiani A, Hanafi M G, Salmanzadeh S, Mirmomeni G, Javadzade Z. Evaluation of the Imaging Characteristics of Rhino-Orbital Cerebral Mucormycosis. WJPS 2025; 14 (2) :79-85
URL: http://wjps.ir/article-1-1464-en.html
URL: http://wjps.ir/article-1-1464-en.html
Ayeh Kiani1 
, Mohammad Ghasem Hanafi2 , Shokrollah Salmanzadeh3 , Golshan Mirmomeni4 , Zahra Javadzade *5
, Mohammad Ghasem Hanafi2 , Shokrollah Salmanzadeh3 , Golshan Mirmomeni4 , Zahra Javadzade *5
1- Department of Otolaryngology, Head and Neck Surgery, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
2- Department of Radiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3- Department of Infectious Diseases, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
5- Department of Otolaryngology, Head and Neck Surgery, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran ,zahrajavadzade4@gmail.com
2- Department of Radiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3- Department of Infectious Diseases, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
5- Department of Otolaryngology, Head and Neck Surgery, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran ,
Abstract: (423 Views)
Background: Mucormycosis is a fungal infection with diverse clinical manifestations, the most common of which, i.e., the classical form of rhino-orbital cerebral mucormycosis (ROCM), has had a significant prevalence among patients recovered from COVID-19. We aimed to investigate the findings of ROCM imaging recorded at Imam Khomeini Hospital in Ahvaz, Iran, in 2022.
Methods: This retrospective study reviewed the files of patients definitively diagnosed with mucormycosis and COVID-19. Imaging procedures performed on patients included non-contrast CT scans (CT imaging protocol: from vertex to mandible without contrast for evaluating sinus contents, bone erosion, osteomyelitis, pre-sinus or orbital invasion). Key imaging findings were assessed and documented, and findings were evaluated.
Results: The mean age of subjects was 53.11 ± 14 years, with the majority being male (55.3%). All subjects had nasal and sinus involvement, but their brains were unaffected. Approximately 36% of subjects had ocular involvement. In imaging findings, left pterygopalatine involvement had the highest prevalence (27.7%), while left extraocular muscle involvement had the lowest prevalence (4.3%). Patients with lamina papyracea and extraocular muscle involvement all had ocular involvement, which was statistically significant. Additionally, those with hard palate erosion had significantly higher ocular involvement rates (5 out of 6 cases with hard palate erosion).
Conclusion: Rhino-orbital cerebral mucormycosis is associated with nasal and sinus involvement, and diabetes and male gender are predisposing factors to this disease. CT, as a complement to other clinical evaluations, dramatically aids in diagnosing and identifying the extent and complications of the disease.
Methods: This retrospective study reviewed the files of patients definitively diagnosed with mucormycosis and COVID-19. Imaging procedures performed on patients included non-contrast CT scans (CT imaging protocol: from vertex to mandible without contrast for evaluating sinus contents, bone erosion, osteomyelitis, pre-sinus or orbital invasion). Key imaging findings were assessed and documented, and findings were evaluated.
Results: The mean age of subjects was 53.11 ± 14 years, with the majority being male (55.3%). All subjects had nasal and sinus involvement, but their brains were unaffected. Approximately 36% of subjects had ocular involvement. In imaging findings, left pterygopalatine involvement had the highest prevalence (27.7%), while left extraocular muscle involvement had the lowest prevalence (4.3%). Patients with lamina papyracea and extraocular muscle involvement all had ocular involvement, which was statistically significant. Additionally, those with hard palate erosion had significantly higher ocular involvement rates (5 out of 6 cases with hard palate erosion).
Conclusion: Rhino-orbital cerebral mucormycosis is associated with nasal and sinus involvement, and diabetes and male gender are predisposing factors to this disease. CT, as a complement to other clinical evaluations, dramatically aids in diagnosing and identifying the extent and complications of the disease.
References
1. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012;54(suppl_1):S23-S34. [DOI:10.1093/cid/cir866]
2. Arora U, Priyadarshi M, Katiyar V, et al. Risk factors for Coronavirus disease-associated mucormycosis. J Infect 2022;84(3):383-90. [DOI:10.1016/j.jinf.2021.12.039]
3. John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: the perfect storm for mucormycosis. J Fungi 2021;7(4):298. [DOI:10.3390/jof7040298]
4. Sarda R, Swain S, Ray A, Wig N. COVID-19-associated mucormycosis: an epidemic within a pandemic. QJM 2021;114(6):355-6. [DOI:10.1093/qjmed/hcab165]
5. González-Martín-Moro J, López-Arcas-Calleja JM, Burgueño-García M, Cebrián-Carretero JL, García-Rodríguez J. Rhinoorbitocerebral mucormycosis: a case report and literature review. Med Oral Patol Oral Cir Bucal 2008;13(12):E792-E5.
6. Bouza E, Muñoz P, Guinea J. Mucormycosis: an emerging disease? Clin Microbiol Infect 2006;12:7-23. [DOI:10.1111/j.1469-0691.2006.01604.x]
7. Sani AT, Fata AM, Arian M. Presenting features and outcome of rhino-orbital-cerebral mucormycosis in two referral center in Mashhad. Tehran University Medical Journal 2014;72(1).
8. Mallis A, Mastronikolis S, Naxakis S, Papadas A. Rhinocerebral mucormycosis: an update. Eur Rev Med Pharmacol Sci 2010;14(11).
9. Bhansali A, Bhadada S, Sharma A, et al. Presentation and outcome of rhino-orbital-cerebral mucormycosis in patients with diabetes. Postgrad Med J 2004;80(949):670-4. [DOI:10.1136/pgmj.2003.016030]
10. McDevitt Jr GR, Brantley MJ, Cawthon MA. Rhinocerebral mucormycosis: a case report with magnetic resonance imaging findings. Clin Imaging 1989;13(4):317-20. [DOI:10.1016/0899-7071(89)90065-X]
11. Press GA, Weindling SM, Hesselink JR, Ochi JW, Harris JP. Rhinocerebral mucormycosis: MR manifestations. J Comput Assist Tomogr 1988;12(5):744-9. [DOI:10.1097/00004728-198809010-00005]
12. Jindal G, Sethi A, Bhargarva K, et al. Imaging findings in invasive rhino-orbito-cerebral mucormycosis in post-COVID-19 patients. Baylor University Medical Center Proceedings; 2022: Taylor & Francis; 2022. p. 32-4. [DOI:10.1080/08998280.2021.1981100]
13. Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 2008;47(4):503-9. [DOI:10.1086/590004]
14. Pathak L, Tripathi A, Nayyar SS, et al. Management of post-COVID mucormycosis at a tertiary care center in Northern India. The Egyptian Journal of Otolaryngology 2023;39(1):19. [DOI:10.1186/s43163-023-00388-1]
15. Dam P, Cardoso MH, Mandal S, et al. Surge of mucormycosis during the COVID-19 pandemic. Travel Med Infect Dis 2023 2023/03/01/;52:102557. [DOI:10.1016/j.tmaid.2023.102557]
16. A GA, Ashraf H, HaiderMehdi HS. Mucormycosis and Covid-19 : Risk Factors, Clinical Presentation and Outcome in a Tertiary Care Centre in North India. J Assoc Physicians India 2022 Apr;70(4):11-2.
17. Nehara HR, Puri I, Singhal V, Sunil I, Bishnoi BR, Sirohi P. Rhinocerebral mucormycosis in COVID-19 patient with diabetes a deadly trio: Case series from the north-western part of India. Indian J Med Microbiol 2021;39(3):380-3. [DOI:10.1016/j.ijmmb.2021.05.009]
18. Sterne JA, Murthy S, Diaz JV, et al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA 2020;324(13):1330-41. [DOI:10.1001/jama.2020.17023]
19. Ahmed N, Mahmood MS, Ullah MA, et al. COVID-19-associated candidiasis: possible patho-mechanism, predisposing factors, and prevention strategies. Curr Microbiol 2022;79(5):127. [DOI:10.1007/s00284-022-02824-6]
20. Chakravarty J, Gupta MK, Tilak R, et al. COVID-19-associated Mucormycosis: A clinico-epidemiological study. J Diabetes Complications 2022;36(9):108284. [DOI:10.1016/j.jdiacomp.2022.108284]
21. Dogra S, Arora A, Aggarwal A, et al. Mucormycosis Amid COVID-19 Crisis: Pathogenesis, Diagnosis, and Novel Treatment Strategies to Combat the Spread. Front Microbiol 2021;12:794176. [DOI:10.3389/fmicb.2021.794176]
22. Pal P, Singh B, Singla S, Kaur R. Mucormycosis in COVID-19 pandemic and its neurovascular spread. Eur Arch Otorhinolaryngol 2021:1-8. [DOI:10.1007/s00405-021-07106-8]
23. Kemper J, Kuijper E, Mirck P, Balm A. Recovery from rhinocerebral mucormycosis in a ketoacidotic diabetic patient: a case report. J Laryngol Otol 1993;107(3):233-5. [DOI:10.1017/S0022215100122716]
24. Hussain S, Salahuddin N, Ahmad I, Salahuddin I, Jooma R. Rhinocerebral invasive mycosis: occurence in immunocompetent individuals. Eur J Radiol 1995;20(2):151-5. [DOI:10.1016/0720-048X(95)00644-6]
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