Clinical Challenges and Predictive Risk Factors for Outcomes in COVID-19-Associated Mucormycosis.

Abstract

Background & objective: Mucormycosis has emerged as a severe complication in COVID-19 patients, particularly among those with uncontrolled diabetes and those receiving corticosteroid therapy. The infection's tendency to spread from the sinuses to the orbit and central nervous system (CNS) significantly increases morbidity and mortality. This study aimed to identify clinical risk factors and outcomes associated with disease severity and mortality in COVID-19-associated mucormycosis (CAM), with a focus on disease progression to orbital and CNS involvement.

Methods: A total of 180 confirmed CAM patients were enrolled and classified into three groups based on disease extent: sinus-only, sinus with orbital involvement, and sinus with both orbital and CNS involvement. Data were collected on demographics, clinical history, laboratory findings, imaging results, treatment modalities, and outcomes.

Results: Of the 180 patients, 63.3% had sinus-only involvement, 23.9% had sinus and orbital involvement, and 12.8% had sinus, orbital, and CNS involvement. Uncontrolled diabetes was observed in 38% of patients and was more prevalent in those with extensive disease. Corticosteroid use was significantly associated with disease severity (p = 0.002). Invasive procedures, such as orbital exenteration, were significantly linked to CNS progression (p < 0.05). The overall mortality rate was 31% (55 of 180 patients).

Conclusion: Uncontrolled diabetes and corticosteroid therapy are major risk factors for severe CAM. Extension of mucormycosis beyond the sinuses, particularly to the orbit and CNS, is associated with poor clinical outcomes and often requires aggressive surgical management. Early diagnosis and prompt intervention are essential to improve survival in these patients.