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Pakdel F, Zand A, Sharifi A, Asadi M, Abri Aghdam K. Challenges and Pitfalls in the Management of Rhino-Orbital Mucormycosis in Ophthalmology: A Highlighted Problem in the COVID-19 Era. JOVR [Internet]. 2022Aug.9 [cited 2024Apr.24];17(3):424–431. Available from: https://knepublishing.com/index.php/JOVR/article/view/11582
https://doi.org/10.18502/jovr.v17i3.11582
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Farzad Pakdel
Farzad Pakdel
Department of Oculo-Facial Plastic Surgery, Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran
-
Amin Zand
Amin Zand
Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Ali Sharifi
Ali Sharifi
Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
-
Masih Asadi
Masih Asadi
Eye Research Center, Eye Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
-
Kaveh Abri Aghdam
Kaveh Abri Aghdam
Eye Research Center, Eye Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Published Date
- Aug 9, 2022
Challenges and Pitfalls in the Management of Rhino-Orbital Mucormycosis in Ophthalmology: A Highlighted Problem in the COVID-19 Era
Abstract
Secondary infections in hospitalized and ill patients with coronavirus disease 2019 (COVID-19) are common. One of these life-threatening infectious diseases is rhino-orbital mucormycosis, which made an outbreak recently. This outbreak was mainly caused by the administration of high-dose corticosteroids in patients with COVID-19, especially those with diabetes mellitus. The increased incidence of rhino-orbital mucormycosis in the COVID-19 era presents different challenges for healthcare providers including ophthalmologists who are directly involved in disease management. We summarized the main challenges and recommendations for ophthalmologists on the management of rhino-orbital mucormycosis.
Keywords:
Not applicanle, None, Not required
References
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2. Pakdel F, Ahmadikia K, Salehi M, Tabari A, Jafari R, Mehrparvar G, et al. Mucormycosis in patients with COVID- 19: A cross-sectional descriptive multicentre study from Iran. Mycoses 2021;64:1238–1252.
3. Raiesi O, Hashemi SJ, Mohammadi Ardehali M, Ahmadikia K, Getso MI, Pakdel F, et al. Molecular identification and clinical features of fungal rhinosinusitis: A 3- year experience with 108 patients. Microb Pathog 2021;158:105018.
4. Hoenigl M, Seidel D, Carvalho A, Rudramurthy SM, Arastehfar A, Gangneux JP, et al. The emergence of COVID-19 associated mucormycosis: Analysis of cases from 18 countries [Internet]. SSRN Electron J [Preprint]. 2021. Available from: https://doi.org/10.2139/ssrn.3844587.
5. Pak J, Tucci VT, Vincent AL, Sandin RL, Greene JN. Mucormycosis in immunochallenged patients. J Emerg Trauma Shock 2008;1:106–113.
6. Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 2014;20:5–26.
7. Smith HW, Kirchner JA. Cerebral mucormycosis; A report of three cases. AMA Arch Otolaryngol 1958;68:715–726.
8. Skiada A, Lass-Floerl C, Klimko N, Ibrahim A, Roilides E, Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol 2018;56:93–101.
9. Herrera DA, Dublin AB, Ormsby EL, Aminpour S, Howell LP. Imaging findings of rhinocerebral mucormycosis. Skull Base 2009;19:117–125.
10. Singh A, Mohanty A, Jha S, Gupta P, Kaistha N. Concomitant mucormycosis with aspergillosis in patients with uncontrolled diabetes mellitus: A case series. J Clin Diagnostic Res 2021;15:DR01–DR03.
11. Nambiar M, Varma SR, Jaber M, Sreelatha SV, Thomas B, Nair AS. Mycotic infections - Mucormycosis and oral candidiasis associated with Covid-19: A significant and challenging association. J Oral Microbiol 2021;13:1967699.
12. Hoenigl M, Seidel D, Carvalho A, Rudramurthy SM, Arastehfar A, Gangneux JP, et al. The emergence of COVID-19 associated mucormycosis: A review of cases from 18 countries. Lancet Microbe 2022. Available from: https://doi.org/10.1016/S2666-5247(21)00237-8
13. Darwish RM, AlMasri M, Al-Masri MM. Mucormycosis: The hidden and forgotten disease. J Appl Microbiol 2022;132:4042–4057.
14. Hamill RJ, Amphotericin B. Amphotericin B formulations: A comparative review of efficacy and toxicity. Drugs 2013;73:919–934.
15. Burke D, Lal R, Finkel KW, Samuels J, Foringer JR. Acute amphotericin B overdose. Ann Pharmacother 2006;40:2254–2259.
16. Soler JA, Ibañez L, Zuazu J, Julià A. Bradycardia after rapid intravenous infusin of amphotericin B. Lancet 1993;341:372–373.
17. Aguado JM, Hidalgo M, Moya I, Alcazar JM, Jimenez MJ, Noriega AR. Ventricular arrhythmias with conventional and liposomal amphotericin. Lancet 1993;342:1239.
18. Laniado-Laborín R, Cabrales-Vargas MN. Amphotericin B: Aide effects and toxicity. Rev Iberoam Micol 2009;26:223– 227.
19. Pilmis B, Jullien V, Sobel J, Lecuit M, Lortholary O, Charlier C. Antifungal drugs during pregnancy: An updated review. J Antimicrob Chemother 2015;70:14–22.
20. Moguchenok EA. [Study of embryotoxic and teratogenic effects of amphotericin B and a methyl derivative of amphotericin B in rats after their intravenous and intraamniotic administration]. Antibiot Khimioter 1992;37:25–28.
21. Spellberg B, Ibrahim A, Roilides E, Lewis RE, Lortholary O, Petrikkos G, et al. Combination therapy for mucormycosis: Why, what, and how? Clin Infect Dis 2012;54:S73–S78.
22. Spellberg B, Fu Y, Edwards JE Jr, Ibrahim AS. Combination therapy with amphotericin B lipid complex and caspofungin acetate of disseminated zygomycosis in diabetic ketoacidotic mice. Antimicrob Agents Chemother 2005;49:830–832.
23. Ibrahim AS, Gebremariam T, Fu Y, Edwards JE Jr, Spellberg B. Combination echinocandin-polyene treatment of murine mucormycosis. Antimicrob Agents Chemother 2008;52:1556–1558.
24. Ullmann AJ, Cornely OA, Burchardt A, Hachem R, Kontoyiannis DP, Töpelt K, et al. Pharmacokinetics, safety, and efficacy of posaconazole in patients with persistent febrile neutropenia or refractory invasive fungal infection. Antimicrob Agents Chemother 2006;50:658–666.
25. Marty FM, Ostrosky-Zeichner L, Cornely OA, Mullane KM, Perfect JR, Thompson GR 3rd, et al. Isavuconazole treatment for mucormycosis: A single-arm open-label trial and case–control analysis. Lancet Infect Dis 2016;16:828– 837.
26. Selarka L, Sharma S, Saini D, Sharma S, Batra A, Waghmare VT, et al. Mucormycosis and COVID-19: An epidemic within a pandemic in India. Mycoses 2021;64:1253–1260.
27. Jiang RS, Hsu SH, Liang KL, Amphotericin B. Amphotericin B nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery. Am J Rhinol Allergy 2015;29:435–440.
28. Jiang RS, Twu CW, Liang KL. Efficacy of nasal irrigation with 200 μg/mL amphotericin B after functional endoscopic sinus surgery: A randomized, placebocontrolled, double-blind study. Int Forum Allergy Rhinol 2018;8:41–48.
29. Shirazi MA, Stankiewicz JA, Kammeyer P. Activity of nasal amphotericin B irrigation against fungal organisms in vitro. Am J Rhinol 2007;21:145–148.
30. Colon-Acevedo B, Kumar J, Richard MJ, Woodward JA. The role of adjunctive therapies in the management of invasive sino-orbital infection. Ophthal Plast Reconstr Surg 2015;31:401–405.
31. Safi M, Ang MJ, Patel P, Silkiss RZ. Rhino-orbitalcerebral mucormycosis (ROCM) and associated cerebritis treated with adjuvant retrobulbar amphotericin B. Am J Ophthalmol Case Rep 2020;19:100771.
32. Hirabayashi KE, Kalin-Hajdu E, Brodie FL, Kersten RC, Russell MS, Vagefi MR. Retrobulbar Injection of amphotericin B for orbital mucormycosis. Ophthal Plast Reconstr Surg 2017;33:e94–e97.
33. Harmsen S, McLaren AC, Pauken C, McLemore R, Amphotericin B. Amphotericin B is cytotoxic at locally delivered concentrations. Clin Orthop Relat Res 2011;469:3016–3021.
34. Brodie FL, Kalin-Hajdu E, Kuo DS, Hirabayashi KE, Vagefi R, Kersten RC. Orbital compartment syndrome following retrobulbar injection of amphotericin B for invasive fungal disease. Am J Ophthalmol Case Rep 2016;1:8–10.
35. Seiff SR, Choo PH, Carter SR. Role of local amphotericin B therapy for sino-orbital fungal infections. Ophthal Plast Reconstr Surg 1999;15:28–31.
36. Joos ZP, Patel BC. Intraorbital irrigation of amphotericin B in the treatment of rhino-orbital mucormycosis. Ophthal Plast Reconstr Surg 2017;33:e13–e16.
37. Songu M, Unlu HH, Gunhan K, Ilker SS, Nese N. Orbital exenteration: A dilemma in mucormycosis presented with orbital apex syndrome. Am J Rhinol 2008;22:98–103.
38. Hargrove RN, Wesley RE, Klippenstein KA, Fleming JC, Haik BG. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg 2006;22:286–2891.
39. Karadeniz Uğurlu Ş, Selim S, Kopar A, Songu M. Rhinoorbital mucormycosis: Clinical findings and treatment outcomes of four cases. Turk J Ophthalmol 2015;45:169– 174.
40. Jain S, Jain P. Rehabilitation of orbital cavity after orbital exenteration using polymethyl methacrylate orbital prosthesis. J Indian Prosthodont Soc 2016;16:100–104.
41. Hussain S, Riad A, Singh A, Klugarová J, Antony B, Banna H, et al. Global prevalence of COVID-19-associated mucormycosis (CAM): Living systematic review and metaanalysis. J Fungi 2021;7:985.
42. Chander J, Kaur M, Singla N, Punia RP, Singhal SK, Attri AK, et al. Mucormycosis: Battle with the Deadly Enemy over a Five-Year Period in India. J Fungi 2018;4:46.
43. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012;54:S23–S34.
44. Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. J Fungi 2019;5:26.
2. Pakdel F, Ahmadikia K, Salehi M, Tabari A, Jafari R, Mehrparvar G, et al. Mucormycosis in patients with COVID- 19: A cross-sectional descriptive multicentre study from Iran. Mycoses 2021;64:1238–1252.
3. Raiesi O, Hashemi SJ, Mohammadi Ardehali M, Ahmadikia K, Getso MI, Pakdel F, et al. Molecular identification and clinical features of fungal rhinosinusitis: A 3- year experience with 108 patients. Microb Pathog 2021;158:105018.
4. Hoenigl M, Seidel D, Carvalho A, Rudramurthy SM, Arastehfar A, Gangneux JP, et al. The emergence of COVID-19 associated mucormycosis: Analysis of cases from 18 countries [Internet]. SSRN Electron J [Preprint]. 2021. Available from: https://doi.org/10.2139/ssrn.3844587.
5. Pak J, Tucci VT, Vincent AL, Sandin RL, Greene JN. Mucormycosis in immunochallenged patients. J Emerg Trauma Shock 2008;1:106–113.
6. Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 2014;20:5–26.
7. Smith HW, Kirchner JA. Cerebral mucormycosis; A report of three cases. AMA Arch Otolaryngol 1958;68:715–726.
8. Skiada A, Lass-Floerl C, Klimko N, Ibrahim A, Roilides E, Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol 2018;56:93–101.
9. Herrera DA, Dublin AB, Ormsby EL, Aminpour S, Howell LP. Imaging findings of rhinocerebral mucormycosis. Skull Base 2009;19:117–125.
10. Singh A, Mohanty A, Jha S, Gupta P, Kaistha N. Concomitant mucormycosis with aspergillosis in patients with uncontrolled diabetes mellitus: A case series. J Clin Diagnostic Res 2021;15:DR01–DR03.
11. Nambiar M, Varma SR, Jaber M, Sreelatha SV, Thomas B, Nair AS. Mycotic infections - Mucormycosis and oral candidiasis associated with Covid-19: A significant and challenging association. J Oral Microbiol 2021;13:1967699.
12. Hoenigl M, Seidel D, Carvalho A, Rudramurthy SM, Arastehfar A, Gangneux JP, et al. The emergence of COVID-19 associated mucormycosis: A review of cases from 18 countries. Lancet Microbe 2022. Available from: https://doi.org/10.1016/S2666-5247(21)00237-8
13. Darwish RM, AlMasri M, Al-Masri MM. Mucormycosis: The hidden and forgotten disease. J Appl Microbiol 2022;132:4042–4057.
14. Hamill RJ, Amphotericin B. Amphotericin B formulations: A comparative review of efficacy and toxicity. Drugs 2013;73:919–934.
15. Burke D, Lal R, Finkel KW, Samuels J, Foringer JR. Acute amphotericin B overdose. Ann Pharmacother 2006;40:2254–2259.
16. Soler JA, Ibañez L, Zuazu J, Julià A. Bradycardia after rapid intravenous infusin of amphotericin B. Lancet 1993;341:372–373.
17. Aguado JM, Hidalgo M, Moya I, Alcazar JM, Jimenez MJ, Noriega AR. Ventricular arrhythmias with conventional and liposomal amphotericin. Lancet 1993;342:1239.
18. Laniado-Laborín R, Cabrales-Vargas MN. Amphotericin B: Aide effects and toxicity. Rev Iberoam Micol 2009;26:223– 227.
19. Pilmis B, Jullien V, Sobel J, Lecuit M, Lortholary O, Charlier C. Antifungal drugs during pregnancy: An updated review. J Antimicrob Chemother 2015;70:14–22.
20. Moguchenok EA. [Study of embryotoxic and teratogenic effects of amphotericin B and a methyl derivative of amphotericin B in rats after their intravenous and intraamniotic administration]. Antibiot Khimioter 1992;37:25–28.
21. Spellberg B, Ibrahim A, Roilides E, Lewis RE, Lortholary O, Petrikkos G, et al. Combination therapy for mucormycosis: Why, what, and how? Clin Infect Dis 2012;54:S73–S78.
22. Spellberg B, Fu Y, Edwards JE Jr, Ibrahim AS. Combination therapy with amphotericin B lipid complex and caspofungin acetate of disseminated zygomycosis in diabetic ketoacidotic mice. Antimicrob Agents Chemother 2005;49:830–832.
23. Ibrahim AS, Gebremariam T, Fu Y, Edwards JE Jr, Spellberg B. Combination echinocandin-polyene treatment of murine mucormycosis. Antimicrob Agents Chemother 2008;52:1556–1558.
24. Ullmann AJ, Cornely OA, Burchardt A, Hachem R, Kontoyiannis DP, Töpelt K, et al. Pharmacokinetics, safety, and efficacy of posaconazole in patients with persistent febrile neutropenia or refractory invasive fungal infection. Antimicrob Agents Chemother 2006;50:658–666.
25. Marty FM, Ostrosky-Zeichner L, Cornely OA, Mullane KM, Perfect JR, Thompson GR 3rd, et al. Isavuconazole treatment for mucormycosis: A single-arm open-label trial and case–control analysis. Lancet Infect Dis 2016;16:828– 837.
26. Selarka L, Sharma S, Saini D, Sharma S, Batra A, Waghmare VT, et al. Mucormycosis and COVID-19: An epidemic within a pandemic in India. Mycoses 2021;64:1253–1260.
27. Jiang RS, Hsu SH, Liang KL, Amphotericin B. Amphotericin B nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery. Am J Rhinol Allergy 2015;29:435–440.
28. Jiang RS, Twu CW, Liang KL. Efficacy of nasal irrigation with 200 μg/mL amphotericin B after functional endoscopic sinus surgery: A randomized, placebocontrolled, double-blind study. Int Forum Allergy Rhinol 2018;8:41–48.
29. Shirazi MA, Stankiewicz JA, Kammeyer P. Activity of nasal amphotericin B irrigation against fungal organisms in vitro. Am J Rhinol 2007;21:145–148.
30. Colon-Acevedo B, Kumar J, Richard MJ, Woodward JA. The role of adjunctive therapies in the management of invasive sino-orbital infection. Ophthal Plast Reconstr Surg 2015;31:401–405.
31. Safi M, Ang MJ, Patel P, Silkiss RZ. Rhino-orbitalcerebral mucormycosis (ROCM) and associated cerebritis treated with adjuvant retrobulbar amphotericin B. Am J Ophthalmol Case Rep 2020;19:100771.
32. Hirabayashi KE, Kalin-Hajdu E, Brodie FL, Kersten RC, Russell MS, Vagefi MR. Retrobulbar Injection of amphotericin B for orbital mucormycosis. Ophthal Plast Reconstr Surg 2017;33:e94–e97.
33. Harmsen S, McLaren AC, Pauken C, McLemore R, Amphotericin B. Amphotericin B is cytotoxic at locally delivered concentrations. Clin Orthop Relat Res 2011;469:3016–3021.
34. Brodie FL, Kalin-Hajdu E, Kuo DS, Hirabayashi KE, Vagefi R, Kersten RC. Orbital compartment syndrome following retrobulbar injection of amphotericin B for invasive fungal disease. Am J Ophthalmol Case Rep 2016;1:8–10.
35. Seiff SR, Choo PH, Carter SR. Role of local amphotericin B therapy for sino-orbital fungal infections. Ophthal Plast Reconstr Surg 1999;15:28–31.
36. Joos ZP, Patel BC. Intraorbital irrigation of amphotericin B in the treatment of rhino-orbital mucormycosis. Ophthal Plast Reconstr Surg 2017;33:e13–e16.
37. Songu M, Unlu HH, Gunhan K, Ilker SS, Nese N. Orbital exenteration: A dilemma in mucormycosis presented with orbital apex syndrome. Am J Rhinol 2008;22:98–103.
38. Hargrove RN, Wesley RE, Klippenstein KA, Fleming JC, Haik BG. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg 2006;22:286–2891.
39. Karadeniz Uğurlu Ş, Selim S, Kopar A, Songu M. Rhinoorbital mucormycosis: Clinical findings and treatment outcomes of four cases. Turk J Ophthalmol 2015;45:169– 174.
40. Jain S, Jain P. Rehabilitation of orbital cavity after orbital exenteration using polymethyl methacrylate orbital prosthesis. J Indian Prosthodont Soc 2016;16:100–104.
41. Hussain S, Riad A, Singh A, Klugarová J, Antony B, Banna H, et al. Global prevalence of COVID-19-associated mucormycosis (CAM): Living systematic review and metaanalysis. J Fungi 2021;7:985.
42. Chander J, Kaur M, Singla N, Punia RP, Singhal SK, Attri AK, et al. Mucormycosis: Battle with the Deadly Enemy over a Five-Year Period in India. J Fungi 2018;4:46.
43. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012;54:S23–S34.
44. Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. J Fungi 2019;5:26.