A menace to human health: rhino-orbital cerebral mucormycosis

Arvind Sharma, Aditi Bharti, Tej Pratap Singh, Richa Sharma


Collate and interpret data on rhino-orbital-cerebral mucormycosis (ROCM) infections admitted at the tertiary care centre and investigate the common contributing factors leading to such infections and highlighting the relationship of this upsurge seen in patients infected with COVID-19. We conducted a cross-sectional study in Central India, in the period of eleven days (from 9 May to 18 May). A total of ten patients with ROCM was investigated, admitted to the separate ward for mucormycosis in the tertiary care centre. A self-pre-designed questionnaire was used for the evaluation. Verbal consent was obtained from the patients before the start of the study and also ensured the confidentiality of their respective details. Among ten of the patients, six patients were known cases of diabetes mellitus, two of the patients were diagnosed with diabetes mellitus after the initiation of corticosteroid therapy during their treatment and two of them were non-diabetic. All the patients in this case series were on corticosteroid therapy and on oxygen supplementation. Majority of the patients showing mild to moderate disease with unilateral symptoms, although only 10% showed the severe disease with bilateral eye involvement. It is evident that the poor or impaired immune functioning is the leading cause of the upsurge in mucormycosis cases. Therefore, early diagnosis and treatment of fungal infections can substantially reduce morbidity and mortality.


Mucormycosis, COVID-19, Diabetes mellitus, Corticosteroid, Amphotericin B, Rhino-orbital-cerebral mucormycosis

Full Text:



James WD, Berger TG, Elston DM, Odom RB. Andrews’ Diseases of the Skin: Clinical Dermatology. 10th ed. Philadelphia: Saunders Elsevier; 2006.

Crum-Cianflone NF. Mucormycosis. eMedicine. 2008.

Suhr J, Draper B. Survivors of Joplin tornado develop rare infection. Assoc Press. 2011.

Spellberg B, Edwards J, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18(3):556-69.

Pasero D, Sanna S, Liperi C, Piredda D, Branca GP, Casadio L, et al. A challenging complication following SARS-CoV-2 infection: a case of pulmonary mucormycosis. Infect. 2020:1-6.

Soumya MS, Hydie MV, Sreenivas VV, Balasubramanya AM. Institutional experience of mucormycosis over a period of 10 years: retrospective case series. Int J Adv Med. 20141(2):141-4.

Moorthy A, Gaikwad R, Krishna S, Hegde R, Tripathi KK, Kale PG, et al. SARS-CoV-2, uncontrolled diabetes and corticosteroids—an unholy trinity in invasive fungal infections of the maxillofacial region? a retrospective, multi-centric analysis. J Maxillofac Oral Surg. 2021:1-8.

Chennamchetty VK, Adimulapu S, Kola BP, Padua MD, Ambika C, Rao MVR. Post-COVID pulmonary mucormycosis- A case report. IP Indian J Immunol Respir Med. 2021;6(1):62-6.

Zilberberg MD, Shorr AF, Huang H, Chaudhari P, Paly VF, Menzin J, et al. Hospital days, hospitalization costs, and inpatient mortality among patients with mucormycosis: a retrospective analysis of US hospital discharge data. BMC Infect Dis. 2014;14:310.

Waldorf AR. Pulmonary defense mechanisms against opportunistic fungal pathogens. Immunol Ser. 1989;47:243-71.

Waldorf AR, Ruderman N, Diamond RD. Specific susceptibity to mucormycosis in murine diabetes and bronchoalveolar macrophage defense mechanisms against Rhizopus. J Clin Invest. 1984;74(1):150-60.

RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalised patients with COVID-19: preliminary report. N Engl J Med. 2021;384(8):693-704.

Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA. 2020;324(4):782-93.

Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus. 2000;12(9):10726.

Werthman-Ehrenreich A. Mucormycosis with orbital compartment Syndrome in a patient with COVID-19. Am J Emerg Med. 2021;264:64-8.

Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-resistant Candida auris infections in critically ill coronavirus disease patients, India, April-July 2020. Emerg Infect Dis. 2020;26(11):2694-6.

Unnikrishnan R, Misra A. Infections and diabetes: risks and mitigation with reference to India. Diab Metabol Synd Clin Res Rev. 2020;14(6):1889-94.

International Diabetes Federation. IDF diabetes atlas. 7th ed. Brussels, Belgium: IDF Diabetes Atlas; 2015.

Sheldon WH, Bauer H. The development of the acute inflammatory response to experimental cutaneous mucormycosis in normal and diabetic rabbits. J Exp Med. 1959;110(6):845-52.

Waldorf AR, Ruderman N, Diamond RD. Specific susceptibility to mucormycosis in murine diabetes and bronchoalveolar macrophage defense against Rhizopus. J Clin Invest. 1984;74(1):150-60.

Rammaert B, Lanternier F, Poirée S, Kania R, Lortholary O. Diabetes and mucormycosis: a complex interplay. Diab Metab. 2012;38(3):193204.