© 2022 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow Rhino-orbital-cerebral mucormycosis: An epidemiological study from a tertiary care referral center in Western India Ravija Patel, Jignesh Jethva, Purvi R Bhagat, Vipul Prajapati, Hansa Thakkar, Kamini Prajapati Access this article online Website: www.ijo.in DOI: 10.4103/ijo.IJO_2943_21 PMID: ***** Quick Response Code: Purpose: Rhino‑orbital‑cerebral mucormycosis (ROCM) is a rare opportunistic fungal infection with a fulminant course and an often fatal outcome. It can occur in immune‑compromised patients such as those having uncontrolled diabetes, on long‑term corticosteroid or immunosuppressive therapy, with COVID‑19 infection, renal failure, AIDS, malignancy, or organ transplant. The aim of our study was to study the epidemiology of mucormycosis in COVID‑19 patients and identify its risk factors. Methods: Ours was an epidemiological study wherein we gathered the demographic, clinical, histopathological, and radiological data of 458 patients of mucormycosis who presented to us between August 2020 and May 2021. Mucormycosis was defined through clinical and radiological findings or positive culture reports. Results: Out of all, 20.74% of patients did not have any past or concurrent history of COVID‑19. The most common symptom of mucormycosis was orbital/facial pain (38.64%) and the most common sign was periocular/facial edema (50.74%). Mucormycosis involving the nose and sinuses (94.54%) was most common followed by rhino‑orbital (45.41%) and brain involvement (10.04%). The most common risk factor for mucormycosis was diabetes [81.92%], followed by corticosteroid use [79.69%] and supplemental oxygen [48.90%]. Most of the patients received similar treatment with IV amphotericin B [88.64%] and local debridement [80.74%]. Conclusion: With the third wave of COVID‑19 still lurking, a fatal fungal infection should be kept in mind in COVID‑19 active as well as recovered patients, especially those who have co‑morbid medical conditions such as uncontrolled diabetes and who are treated with large doses of corticosteroids. Key words: COVID‑19, diabetes, fungal infection, opportunistic, rhino‑orbital‑cerebral mucormycosis Glaucoma unit, Department of ophthalmology, M & J Western Regional Institute of Ophthalmology, Civil Hospital, Ahmedabad, Gujarat, India Correspondence to: Dr. Jignesh Jethva, C1‑202, Spectrum Tower, Opp‑ Police Head Quarter, Shahibaug, Ahmedabad ‑ 380 004, Gujarat, India. E‑mail: jigneshjethva32@gmail.com Received: 22‑Nov‑2021 Revision: 16-Jan-2022 Accepted: 08‑Feb‑2022 Published: 22-Mar-2022 COVID‑19 pandemic, an outbreak of coronavirus disease, was frst identifed in December 2019. The severity of the disease has been ranging from asymptomatic infection to respiratory failure and death. [1] Secondary fungal or bacterial infections or co‑infections are important challenges, which increase the patients’ morbidity and mortality. [1] Mucormycosis is currently a common fungal infection reported as a superinfection in COVID‑19 patients. [2] Zygomycetes comprises mucorales and entomophthorales. The former order causes life‑threatening fungal infections such as mucormycosis mainly in immuno‑compromised hosts, whereas the later order causes superfcial and mucocutaneous infections in immuno‑competent hosts. Among the family of Mucoraceae, Rhizopus oryzae is the most common cause of infection. [3] Phagocytes are the major host defense mechanism against mucormycosis. [4,5] Systemic corticosteroid treatment affects the ability of these macrophages to prevent the germination of the fungal spores. The inappropriate use of corticosteroids for modulating immune‑related lung injury and reducing the mortality rate in COVID‑19 patients needing respiratory support and supplementary oxygen may predispose the patients to secondary infections, ultimately increasing the risk of mortality. [6] Uncontrolled diabetes mellitus is also the most common risk factor identifed in patients with mucormycosis in COVID‑19. [7] A hallmark of mucormycosis infection is the presence of extensive angioinvasion with resultant vessel thrombosis and tissue necrosis. [8] The infection can directly spread into the paranasal sinuses and then invade into orbital and intracranial spaces by direct spread or via the bloodstream. [8] This form is rhino‑orbito‑cerebral mucormycosis (ROCM) is the most common type of human mucormycosis. [6] The second wave of COVID‑19 disease has seen a surge in the incidence of invasive mucormycosis. We have come across hundreds of cases having varied presentations and outcomes. We conducted a study of ROCM in an atempt to study its epidemiology and risk factors. As per our knowledge, these data are the highest series reported from a single‑center to date. With the possibility of further spikes of COVID‑19, the study results may guide the prevention of another mucor epidemic. Methods Ours is an epidemiological study wherein we report the details of 458 patients of mucormycosis who presented to us between Cite this article as: Patel R, Jethva J, Bhagat PR, Prajapati V, Thakkar H, Prajapati K. Rhino-orbital-cerebral mucormycosis: An epidemiological study from a tertiary care referral center in Western India. Indian J Ophthalmol 2022;70:1371-5. 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