Increased incidence of rhino‐orbital mucormycosis in an educational therapeutic hospital during the COVID‐19 pandemic in western Iran: An observational study

Avatef Fazeli, Manouchehr; Rezaei, Leila; Javadirad, Etrat; Iranfar, Khosro; Khosravi, Abbas; Amini Saman, Javad; Poursabbagh, Pardis; Ghadami, Mohammad Rasoul; Parandin, Mohammad Mehdi; Dehghani, Amrollah; Ahmadi Jouybari, Touraj; Mahdavian, Behzad; Eivazi, Nastaran; rezaei, Sohbat; Rezaei, Alireza; Emami, Bashir; Haqgou, Mohadeseh; Bozorgomid, Arezoo; Sayad, Babak

BACKGROUND: COVID‐19 patients, especially the patients requiring hospitalisation, have a high risk of several complications such as opportunistic bacterial and fungal infections. Mucormycosis is a rare and opportunistic fungal infection that mainly affects diabetic and immunocompromised patients. An increase has been observed in the number of rhino‐orbital mucormycosis in patients with COVID‐19 admitted to Imam Khomeini Hospital, Kermanshah, Iran, since October 2020. This is a report of the frequency, risk factors, clinical manifestations, treatment and prognosis of COVID‐19 associated with mucormycosis infection. METHODS: The medical records of COVID‐19 patients with rhino‐orbital mucormycosis who were diagnosed in an educational therapeutic hospital in Kermanshah, west of Iran were surveyed. Several parameters were analysed including demographic, clinical, therapeutic and laboratory characteristics. RESULTS: Twelve patients with COVID‐19–associated rhino‐orbital mucormycosis were identified from 12 October to 18 November 2020. All cases reported as proven mucormycosis had a history of hospitalisation due to COVID‐19. Comorbidities mainly included diabetes mellitus (83.33%) and hypertension (58.33%). Seventy‐five per cent of patients received corticosteroids for COVID‐ 19 treatment. The sites of involvement were rhino‐sino‐orbital (83%) and rhino‐sino (17%). Amphotericin B/liposomal amphotericin B alone or in combination with surgical debridement or orbital exenteration was used as the first‐line therapy. The overall mortality rate was 66.7% (8/12). CONCLUSIONS: We found a high incidence of mucormycosis among COVID‐19 patients. Diabetes mellitus and corticosteroid use were the dominant predisposing factor of mucormycosis. Mucormycosis is a life‐threatening and opportunistic infection; therefore, physicians should know the signs and symptoms of the disease so that a timely diagnosis and therapy can be performed.