Clinical, Epidemiological, and Oral-Related Factors in Post-COVID-19 Mucormycosis Patients: A Systematic Review of Case Reports
DOI:
https://doi.org/10.15517/avtefb51Keywords:
Mucormycosis; Case reports; COVID 19; Oral medicine; Systematic review; Oral health.Abstract
Oral mucormycosis has become a significant concern due to increased cases during the COVID-19 pandemic, potentially linked to corticosteroid-induced immune suppression. This study reviews case reports to identify and describe the clinical and epidemiological factors associated with post-COVID-19 mucormycosis from a dental perspective. A comprehensive search of PubMed, Google Scholar, DOAJ, and NIH Library databases yielded 32 relevant case reports from an initial 180. The average age of patients was 53 years, with 21.9% having a confirmed COVID-19 diagnosis one month prior to mucormycosis diagnosis. Corticosteroid use was reported in 65.6% of cases. Common symptoms included pain (65.6%), swelling (21.9%), and ocular pain (12.5%), with Amphotericin B being the predominant treatment (59.4%). Oral manifestations such as maxillary bone exposure (21.9%) and dental abscesses (31.3%) were noted. This study highlights a potential link between corticosteroids and mucormycosis, despite limitations in report consistency and follow-up data, offering valuable insights for clinical management of post-COVID-19 mucormycosis.
References
“Archived: WHO Timeline - COVID-19.” Accessed: Apr. 23, 2024. [Online]. Available: https://www.who.int/news/item/27-04-2020-who-timeline---covid-19
K. Pushparaj et al., “Mucormycosis (black fungus) ensuing COVID-19 and comorbidity meets - Magnifying global pandemic grieve and catastrophe begins,” Science of The Total Environment, vol. 805, p. 150355, Jan. 2022, doi: 10.1016/j.scitotenv.2021.150355
S. Chillana and K. A. Mohit Chilana, “COVID-19 and Mucormycosis: A Black Fungus Disaster?,” Indian J Dermatol, vol. 67, no. 5, pp. 535-538, 2022, doi: 10.4103/ijd.ijd_17_22
“Why is COVID-19 data being presented as weekly statistics?” Accessed: Apr. 22, 2024. [Online]. Available: https://data.who.int/dashboards/covid19/cases?n=c
M. S. Bhandari, S. Pandey, A. Dabral, R. K. Meena, and R. Kant, “Global Forestry Perspective: COVID-19 Impact and Assessment,” National Academy Science Letters, vol. 44, no. 6, pp. 571-574, Dec. 2021, doi: 10.1007/s40009-021-01062-x
A. Kumari, R. Tewari, and R. Singh, “Antagonistic Interaction of Staphylococcus aureus and Staphylococcus epidermidis with Rhizopus arrhizus Mediated by Phenol Soluble Modulins and Organic Acids,” ACS Infect Dis, vol. 5, no. 11, pp. 1887-1895, Nov. 2019, doi: 10.1021/acsinfecdis.9b00205
L. C. García-Carnero and H. M. Mora-Montes, “Mucormycosis and COVID-19-Associated Mucormycosis: Insights of a Deadly but Neglected Mycosis,” Journal of Fungi, vol. 8, no. 5, p. 445, Apr. 2022, doi: 10.3390/jof8050445
N. Chandwani et al., “Oral Tissue Involvement and Probable Factors in Post-COVID-19 Mucormycosis Patients: A Cross-Sectional Study,” Healthcare, vol. 10, no. 5, p. 912, May 2022, doi: 10.3390/healthcare10050912
M. Nambiar, S. R. Varma, M. Jaber, S. V. Sreelatha, B. Thomas, and A. S. Nair, “Mycotic infections-mucormycosis and oral candidiasis associated with Covid-19: a significant and challenging association,” J Oral Microbiol, vol. 13, no. 1, Jan. 2021, doi: 10.1080/20002297.2021.1967699
L. A. Stewart et al., “Preferred Reporting Items for a Systematic Review and Meta-analysis of Individual Participant Data,” JAMA, vol. 313, no. 16, p. 1657, Apr. 2015, doi: 10.1001/jama.2015.3656
“PROSPERO.” Accessed: Apr. 22, 2024. [Online]. Available: https://www.crd.york.ac.uk/prospero/
R. P. C. Lira and E. M. Rocha, “PICOT: Imprescriptible items in a clinical research question,” Arq Bras Oftalmol, vol. 82, no. 2, 2019, doi: 10.5935/0004-2749.20190028
Z. Munn et al., “Methodological quality of case series studies: an introduction to the JBI critical appraisal tool.,” JBI Evid Synth, vol. 18, no. 10, pp. 2127-2133, Oct. 2020, doi: 10.11124/JBISRIR-D-19-00099.
“Search | Mendeley.” Accessed: Apr. 22, 2024. [Online]. Available: https://www.mendeley.com/search/
J. P. T. Higgins et al., “A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E),” Environ Int, vol. 186, p. 108602, Apr. 2024, doi: 10.1016/j.envint.2024.108602
J. L. Aguayo-Albasini, B. Flores-Pastor, and V. Soria-Aledo, “Sistema GRADE: clasificación de la calidad de la evidencia y graduación de la fuerza de la recomendación,” Cir Esp, vol. 92, no. 2, pp. 82-88, Feb. 2014, doi: 10.1016/j.ciresp.2013.08.002
M. Campbell et al., “Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline,” BMJ, p. l6890, Jan. 2020, doi: 10.1136/bmj.l6890
A. Agarwal, M. Ratre, G. Uikey, and V. Newaskar, “Post-COVID mucormycosis in presentation of periodontal abscess,” J Family Med Prim Care, vol. 12, no. 1, p. 168, 2023, doi: 10.4103/jfmpc.jfmpc_1462_22
K. Alekseyev, L. Didenko, and B. Chaudhry, “Rhinocerebral Mucormycosis and COVID-19 Pneumonia,” J Med Cases, vol. 12, no. 3, pp. 85-89, 2021, doi: 10.14740/jmc3637
S. A. Alramadhan, S. S. Sam, S. Young, D. M. Cohen, M. N. Islam, and I. Bhattacharyya, “COVID-related mucormycosis mimicking dental infection,” Oral Maxillofac Surg Cases, vol. 9, no. 2, p. 100310, Jun. 2023, doi: 10.1016/j.omsc.2023.100310
O. S. Janjua et al., “Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes,” Journal of Fungi, vol. 8, no. 1, p. 44, Dec. 2021, doi: 10.3390/jof8010044
P. Arora, G. Kaur, N. Tyagi, and M. K. Nair, “Maxillary mucormycosis and concurrent osteomyelitis in a post-COVID-19 patient with new onset diabetes mellitus,” Baylor University Medical Center Proceedings, vol. 36, no. 3, pp. 389-391, May 2023, doi: 10.1080/08998280.2023.2177081
W. Arshad, M. M. Kamal, Z. Rafique, M. Rahat, and H. Mumtaz, “Case of maxillary actinomycotic osteomyelitis, a rare post COVID complication-case report,” Annals of Medicine & Surgery, vol. 80, Aug. 2022, doi: 10.1016/j.amsu.2022.104242
I. I. Artopoulou, E. Kalfarentzos, G. Polyzois, and C. Perisanidis, “Prosthodontic restoration of a COVID-19 associated mucormycosis defect: A clinical report,” Special Care in Dentistry, vol. 43, no. 5, pp. 696-700, Sep. 2023, doi: 10.1111/scd.12809
A. I. Aswin, S. Gunasekaran, P. Thankappan, and T. I. Joseph, “An atypical case report of extensive mucormycotic osteomyelitis of maxilla as a consequence of post-COVID complication.,” Dent Res J (Isfahan), vol. 19, p. 60, 2022.
L. Bhanumurthy, Ps. Krishna, P. Sekhar, and L. Makesh Raj, “Post coronavirus disease mucormycosis involving the mandible: A case report with brief note on literature,” Journal of Oral and Maxillofacial Pathology, vol. 25, no. 3, p. 407, 2021, doi: 10.4103/jomfp.jomfp_355_21
R. Chakraborty, D. Pandya, P. Dausage, and A. Chawla, “Mucormycosis-The deadly fungus-A case report with dental perspective,” J Family Med Prim Care, vol. 11, no. 4, p. 1532, 2022, doi: 10.4103/jfmpc.jfmpc_1339_21
C. Dahihandekar, S. Pisulkar, M. Patra, and A. Bansod, “Orbital rehabilitation of a COVID-19-induced mucormycotic defect – A case report,” J Family Med Prim Care, vol. 11, no. 11, p. 7419, 2022, doi: 10.4103/jfmpc.jfmpc_575_22
A. J. Deek, S. Boukovalas, C. J. Rathfoot, and J. E. Gotcher, “Rhinocerebral Mucormycosis as a Sequelae of COVID-19 Treatment: A Case Report & Literature Review,” Journal of Oral and Maxillofacial Surgery, vol. 80, no. 2, pp. 333-340, Feb. 2022, doi: 10.1016/j.joms.2021.09.009.
P. GB et al., “Accidental finding of COVID-associated mucormycosis (CAM) in a patient presenting as toothache: A case report and review of literature,” Clin Case Rep, vol. 11, no. 5, May 2023, doi: 10.1002/ccr3.7292
D. Gupta and T. Dosi, “A rare entity to major outbreak: a case report on mucormycosis,” Pan African Medical Journal, vol. 39, 2021, doi: 10.11604/pamj.2021.39.183.30479
Y. Ingle, S. C. Sarode, G. Sarode, M. Ingle, and S. Ingle, “Concurrent plexiform ameloblastoma and COVID-19-associated mucormycosis of the maxilla,” Oral Oncol, vol. 125, p. 105712, Feb. 2022, doi: 10.1016/j.oraloncology.2022.105712
M. K. Jawanda, R. Narula, S. Gupta, V. Sharma, P. Gupta, and M. Kaur, “Dual Fungal Infections (Aspergillosis and Mucormycosis) in a Diabetic Mellitus Patient Leading to Maxillary Sinusitis as a Post-COVID Manifestation: First Case Report,” Acta Medica (Hradec Kralove, Czech Republic), vol. 64, no. 4, pp. 227-231, 2021, doi: 10.14712/18059694.2022.7
A. Kanaparti, A. Alwala, N. K Chaitanya, D. Chikte, N. Jakkula, and M. Balaindra, “Rhino-orbital mucormycosis in COVID-19 (Corona Virus Disease): A case report,” J Family Med Prim Care, vol. 11, no. 6, p. 3321, 2022, doi: 10.4103/jfmpc.jfmpc_1194_21
Y.-H. Kang et al., “Mucormycosis-related osteomyelitis of the maxilla in a post-COVID-19 patient,” Imaging Sci Dent, vol. 52, no. 4, p. 435, 2022, doi: 10.5624/isd.20220143
S. B. Kankam, H. Saffar, M. Shafizadeh, S. Afhami, and A. Khoshnevisan, “Intraventricular CNS aspergillosis in a patient with prior history of COVID-19: Case report and review of literature,” Annals of Medicine & Surgery, vol. 80, Aug. 2022, doi: 10.1016/j.amsu.2022.104122
H. Khoshkhou, M. Hasheminasab, D. Goudarzi Pour, R. Jamali, G. Morshedzadeh Tehrani, and N. Moslemi, “Multiple maxillary periodontal abscesses as a manifestation of post-coronavirus disease 2019 mucormycosis: a case report,” J Med Case Rep, vol. 17, no. 1, p. 74, Mar. 2023, doi: 10.1186/s13256-023-03792-6.
A. Maini, G. Tomar, D. Khanna, Y. Kini, H. Mehta, and V. Bhagyasree, “Sino-orbital mucormycosis in a COVID-19 patient: A case report,” Int J Surg Case Rep, vol. 82, p. 105957, May 2021, doi: 10.1016/j.ijscr.2021.105957
S. Mehta and A. Pandey, “Rhino-Orbital Mucormycosis Associated With COVID-19,” Cureus, Sep. 2020, doi: 10.7759/cureus.10726
S. Patil and G. Gondhali, “COVID-19 pneumonia with pulmonary tuberculosis: Double trouble.,” Int J Mycobacteriol, vol. 10, no. 2, pp. 206-209, 2021, doi: 10.4103/ijmy.ijmy_51_21
P. Ramani, R. Krishnan, D. Pandiar, Jg. Benitha, K. Ramalingam, and S. Gheena, “Chronic invasive aspergillosis with fulminant mucormycosis sparing palate in a Post-COVID-19 patient - A case report,” Ann Maxillofac Surg, vol. 12, no. 1, p. 102, 2022, doi: 10.4103/ams.ams_296_21
A. Sneha, S. Kumar M P, M. Krishnan, P. Dhasarathan, and H. O R Muralidoss, “Resection and Rehabilitation for COVID-19 Associated Rhino-Maxillary Mucormycosis: A Case Report,” Cureus, May 2023, doi: 10.7759/cureus.39670
S. Upadhyay, T. Bharara, M. Khandait, A. Chawdhry, and B. B. Sharma, “Mucormycosis-resurgence of a deadly opportunist during COVID-19 pandemic: Four case reports,” World J Clin Cases, vol. 9, no. 36, pp. 11338-11345, Dec. 2021, doi: 10.12998/wjcc.v9.i36.11338
R. R, M. Thanthoni, and A. S. Warrier, “COVID-19 Coinfection With Mucormycosis in a Diabetic Patient,” Cureus, Jun. 2021, doi: 10.7759/cureus.15820
M. K. Jawanda, R. Narula, S. Gupta, V. Sharma, S. K. Sidhu, and N. Kaur, “Mixed Infections (Mucormycosis, Actinomycosis and Candidiasis) Leading to Maxillary Osteomyelitis in a Diabetic Mellitus Patient in Post COVID Phase: First Case Report,” Acta Medica (Hradec Kralove, Czech Republic), vol. 64, no. 4, pp. 218-223, 2021, doi: 10.14712/18059694.2022.5
R. Chakraborty, D. Pandya, P. Dausage, and A. Chawla, “Mucormycosis - The deadly fungus-A case report with dental perspective,” J Family Med Prim Care, vol. 11, no. 4, p. 1532, 2022, doi: 10.4103/jfmpc.jfmpc_1339_21
J. A. Al-Tawfiq et al., “COVID-19 and mucormycosis superinfection: the perfect storm,” Infection, vol. 49, no. 5, pp. 833–853, Oct. 2021, doi: 10.1007/s15010-021-01670-1
L. Selarka et al., “Mucormycosis and COVID-19: An epidemic within a pandemic in India,” Mycoses, vol. 64, no. 10, pp. 1253-1260, Oct. 2021, doi: 10.1111/myc.13353
M. Sen, S. Honavar, N. Sharma, and M. Sachdev, “COVID-19 and Eye: A Review of Ophthalmic Manifestations of COVID-19,” Indian J Ophthalmol, vol. 69, no. 3, p. 488, 2021, doi: 10.4103/ijo.IJO_297_21
M. K. Jawanda, R. Narula, S. Gupta, V. Sharma, S. K. Sidhu, and N. Kaur, “Mixed Infections (Mucormycosis, Actinomycosis and Candidiasis) Leading to Maxillary Osteomyelitis in a Diabetic Mellitus Patient in Post COVID Phase: First Case Report,” Acta Medica (Hradec Kralove, Czech Republic), vol. 64, no. 4, pp. 218-223, 2021, doi: 10.14712/18059694.2022.5
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