A comparative study of risk factors of rhino orbital cerebral mucormycosis (ROCM) in COVID-19 patients

Background: Coronavirus disease 2019 (COVID-19) outbreak has created a global health crisis. Amidst the pandemic, there was a massive surge of mucormycosis cases in COVID-19 patients. Uncertainties of pandemic times, accentuated by frequent changes in treatment guidelines, lead to widespread, often inadvertent, use of broad-spectrum antibiotics, and immune-modulators. This has been implicated in the increased incidence of bacterial and fungal co-infections in COVID-19 patients. Objective: We aim to study the clinical profile of patients of SARS-CoV-2 with rhino-orbital-cerebral mucormycosis (ROCM) and the predisposing factors. Methods: RT-PCR positive SARS-CoV-2 patients were recruited so as to populate two different verticals – ROCM (n = 66) group and non-ROCM (n = 132) group. The demographic profile, co-morbidities, vaccination status, treatment received, and other exposures were compared between the two groups. Result: Meantime to develop ROCM from the onset of initial symptoms of COVID-19 was 19.22 ± 8.12 days. Headache was the most common symptom of ROCM, followed by peri-orbital discoloration and cranial nerve involvement. Diabetes mellitus and/or uncontrolled blood sugar were the most important co-morbidities (91%). Steroids were received by 97% vs 100% patients in ROCM and non ROCM groups (p = 0.046). Conclusion: Diabetes mellitus/uncontrolled blood sugar levels, steam inhalation, and hyperferritinemia were found to be the major predisposing factors in the development of ROCM. On the contrary, we observed that the use of steroids/immune-modulators in high doses and for prolonged duration did not predispose the patients of COVID-19 to the development of ROCM. The severity of COVID-19 infection, per se, did not increase the risk of developing ROCM.