Annals of Indian Academy of Neurology
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Year : 2022  |  Volume : 25  |  Issue : 1  |  Page : 68-75

Rhino-orbito-cerebral mycosis and COVID-19: From bad to worse?

1 Department of Neurology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
2 Department of Neurology, Radiant Superspeciality Hospital, Amravati, Maharashtra, India
3 United Ciigma Hospital, Aurangabad, Maharashtra, India
4 Department of Neurology, Sahyadri Hospital, Nashik, Maharashtra, India
5 Dhonde Hospital, Nanded, Maharashtra, India
6 Department of Neurology, Viveka Hospitals Pvt Ltd, Nagpur, Maharashtra, India
7 Noble Hospital, Akola, Maharashtra, India
8 Department of Neurology, Ashwini Sahakari Rugnalaya, Solapur, Maharashtra, India
9 Diamond Superspeciality Hospital, Kolhapur, Pune, Maharashtra, India
10 Department of Neurology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
11 Karuna Hospital, Mumbai, Maharashtra, India, Indiaz
12 Department of Neurology, Dr. LH Hiranandani Hospital, Mumbai, Maharashtra, India
13 Department of Neurology, RGMC and CSM Hospital, Thane, Maharashtra, India
14 Department of Neurology, Bhaktivedanta Hospital and Research Center, Mira Road, Thane, Maharashtra, India
15 Jupiter Hospital, Thane, Maharashtra, India
16 Department of Neurology, Dr D. Y. Patil Medical College, Hospital and Research Center, Pune, Maharashtra, India
17 Vedant Multispeciality Hospital, Chinchwad, Pune, Maharashtra, India
18 Department of Neurology, Sahyadri Super Speciality Hospital, Pune, Maharashtra, India
19 Department of Neurology, Noble Hospital, Pune, Maharashtra, India
20 Neurology Clinic, Baner, Maharashtra, India
21 Department of Microbiology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
22 Department of Infectious Disease, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India

Correspondence Address:
Rahul Kulkarni
Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.aian_463_21

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Background: There has been an increase an alarming rise in invasive mycoses during COVID-19 pandemic, especially during the second wave. Aims: Compare the incidence of invasive mycoses in the last three years and study the risk factors, manifestations and outcomes of mycoses in the COVID era. Methodology: Multicentric study was conducted across 21 centres in a state of western India over 12-months. The clinico-radiological, laboratory and microbiological features, treatment and outcomes of patients were studied. We also analysed yearly incidence of rhino-orbito-cerebral mycosis. Results: There was more than five-times rise in the incidence of invasive mycoses compared to previous two-years. Of the 122 patients analysed, mucor, aspergillus and dual infection were seen in 86.9%, 4.1%, and 7.4% respectively. Fifty-nine percent had simultaneous mycosis and COVID-19 while rest had sequential infection. Common presenting features were headache (91%), facial pain (78.7%), diplopia (66.4%) and vison loss (56.6%). Rhino-orbito-sinusitis was present in 96.7%, meningitis in 6.6%, intracranial mass lesions in 15.6% and strokes in 14.8%. A total of 91.8% patients were diabetic, while 90.2% were treated with steroids during COVID-19 treatment. Mortality was 34.4%. Conclusion: Invasive fungal infections having high mortality and morbidity have increased burden on already overburdened healthcare system. Past illnesses, COVID-19 itself and its treatment and environmental factors seem responsible for the rise of fungal infection. Awareness and preventive strategies are the need of hours and larger studies are needed for better understanding of this deadly disease.

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