Practice of Steam Inhalation at Home - A Major Contributory Risk Factor for Development of Rhino-Orbital Cerebral Mucormycosis (ROCM) in COVID-19 Patients
Year: 2024
Type: article
Study design: Observational Study
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.
Authors: Nishant Agrawal, Rishu Garg, Rahul Jain
Institution: Sri Aurobindo Institute of Medical Sciences
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4393009761