Year: 2024 | Month: March | Volume: 14 | Issue: 3 | Pages: 143-150
DOI: https://doi.org/10.52403/ijhsr.20240321
Practice of Steam Inhalation at Home - A Major Contributory Risk Factor for Development of Rhino-Orbital Cerebral Mucormycosis (ROCM) in COVID-19 Patients
Dr. Nishant Agrawal1, Dr. Rishu Garg2, Dr. Rahul Jain3, Dr. Kapil Telang4, Dr. Ajoy Sodani5
1,2,4Senior Resident, Department of Neurology, Sri Aurobindo Institute of Medical Sciences, Indore.
3Professor & Head, Department of Neurology, Sri Aurobindo Institute of Medical Sciences, Indore.
5Professor, Department of Neurology, Sri Aurobindo Institute of Medical Sciences, Indore.
Corresponding Author: Dr. Nishant Agrawal
ABSTRACT
BACKGROUND: Coronavirus disease (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.
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. We aim to study the clinical profile of patients of SARS CoV-2 with rhino-orbital-cerebral mucormycosis (ROCM) and the predisposing factors.
RESULT: 66 ROCM and age matched 132 non-ROCM subjects were recruited in the study. The mean age of ROCM patients was 51.12±12.2 yr with male preponderance in ROCM group (81.8 vs 63.6, p= 0.008, 95% CI 4.7-29.5). 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. Uncontrolled blood sugar was the most important co-morbidity (91%). Steroids were received by 97% vs. 100% patients in ROCM and non ROCM groups (p=0.046).
CONCLUSION: Steam inhalation, uncontrolled blood sugar levels, and hyperferritinemia were found to be the major predisposing factors in the development of ROCM. Alarmingly, 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.
Key words: Rhino orbital cerebral mucormycosis, Covid-19, steroids, diabetes mellitus, hyperferritinemia.