Investigating the survival rate and causes of the spread of rhinocerebral mucormycosis complications during three years of the covid-19 pandemic

Abstract

Rhinocerebral mucormycosis is a rare but lethal fungal infection that primarily occurs in immunocompromised patients, particularly those with diabetes mellitus. These patients have been predisposed to mucormycosis due to the widespread use of corticosteroids for managing pulmonary inflammation in COVID-19 and inadequate blood sugar control. Unfortunately, at Imam Reza Hospital in Tabriz, we have witnessed a significant number of affected patients over the past three years, similar to treatment centers worldwide, leading to fatalities in young patients and cases of blindness. The timing of surgical interventions and complications during hospitalization has been emphasized. Given that Imam Reza Educational and Treatment Center was the primary facility admitting these patients, the aim of the present study is to evaluate the survival rates and the causes of complications associated with rhinocerebral mucormycosis during the three years of the COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted on 111 hospitalized patients diagnosed with probable mucormycosis during the three years of the COVID-19 pandemic at Imam Reza Hospital, confirmed by biopsy. For data collection, medical records of patients with a definitive diagnosis of mucormycosis stored in the hospital’s archive were reviewed. The study examined data such as the history of diabetes, prior COVID-19 infection within the last three months (based on positive PCR tests or clinical findings), history of immunocompromising conditions including cancers, organ transplant history, and recent high-dose corticosteroid use. The study assessed the relationship between the duration of symptoms, symptom severity, the interval between symptom onset and initiation of medical treatment, and the time between symptom onset and surgical intervention. Findings: In this study a significant relationship was observed between diabetes and blood sugar level, corticosteroid use and underlying disease with sever mucurmycosis complications and also the findings indicated that a time frame of less than 5-2 days from mucormycosis diagnosis to surgical intervention, and less than 24 hours from diagnosis to surgery, significantly contributes to preventing blindness and severe complications. Thus, there is an urgent need for prompt initiation of medical treatment and timely surgical intervention. Notably, three variables—visual impairment, the duration from mucormycosis onset to surgery, and the presence of necrosis—were identified as the most sensitive indicators of severe complications in these patients.