Post-COVID-19 mucormycosis of maxillofacial area

Purpose. In 2019, the world faced the global Covid-19 pandemic. To date, protocols for the treatment and prevention of the novel coronavirus infection have been developed, but the problem of post-Covid complications, including severe ones, remains largely understudied. In this review, we discuss a rather formidable complication of the novel coronavirus infection, namely, post-Covid mucormycosis (“black mold”) of the maxillofacial region, which is caused by various species of fungi of the Mucorales family. CAM (COVID-19-associated mucormycosis) occurs in immunocompromised patients 1-3 weeks after the coronavirus infection and is characterized by an extensive involvement of the maxillofacial region. Untimely detection and irrational treatment can lead to complications, such as face deformities, loss of vision, meningitis, and even death. Low physician awareness of this disease is a determining factor in the development of severe sequelae. Therefore, the purpose of this study was to assess the CAM prevalence, demographic characteristics, profile of comorbidities, and to identify potential risk factors.

Results. Data from 261 patients were reviewed, including 193 (73.9%) males and 68 (26.05%) females. In all cases, the diagnosis of COVID-19 was based on the reverse transcriptase polymerase chain reaction testing of nasopharyngeal/ oropharyngeal swabs, and mucormycosis was confirmed by histopathology and/or culture. In 220 (84.3%) patients, CAM developed either during treatment or after recovery from COVID-19, and 41 (15.7%) had concomitant COVID-19 infection. All cases presented with rhino-orbital or rhino-orbital-cerebral type, except one case that demonstrated rhino-orbital-cerebral form with a simultaneous involvement of the lungs, hard palate, and maxillary sinus. Intracranial spread was noted in 64 (24.5%) cases. In total, 224 (85.8%) patients suffered from diabetes mellitus (DM), of which 68 (30.3%) had poor glycemic control. Other comorbidities included arterial hypertension (31.03%), coronary heart disease (3.4%), chronic kidney disease (4.9%), other heart diseases (5.3%), HIV (0.7%), hematological malignancies (1.1%), and ongoing immunomodulatory treatment (2.2%), with or without concomitant DM. More than one concomitant disorder was noted in 153 (58.6%) cases. Several patients did not report any comorbidities (n=5; 1.9%).

Conclusion. The likelihood of invasive secondary fungal infection development in high-risk patients with COVID-19 is high. To avoid the “black mold” spread, the use of antibiotics and hormonal medications in mild to moderate COVID-19 should be minimized. Treating physicians should be aware of the risk of mucormycosis in patients with uncontrolled DM and severe COVID-19 exhibiting rhino-orbital or rhino-cerebral syndromes. Proper anticoagulant and hormonal treatment can prevent fungal infection.

Key words: rhino-cerebral mucormycosis, rhino-orbital-cerebral mucormycosis, COVID-19–associated mucormycosis

Conflicts of interest. The authors have no conflicts of interest to declare.

Funding. There was no funding for this study