Rhino-orbital Fungal Invasion in Post COVID-19 Cases at a Tertiary Eye Care Centre in Hyderabad- A Cross-sectional Study

Introduction: In India, especially in Southern part of the country during the second wave of the pandemic there has been a sudden surge of rhino-orbital invasion by various fungi like Fusarium, Mucor, Aspergillus etc., in post Coronavirus Disease-2019 (COVID-19) patients. Several risk factors have been attributed like lowering of cell-mediated immunity by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), lymphopenia and associated reduction in CD4+ (Cluster of Differentiation) and CD8+ cell population, Steroid-induced hyperglycaemia, immunosuppression, and uncontrolled diabetes.

Aim: To detect rhino-orbital fungal conquering post COVID-19 cases.

Materials and Methods: This was a cross-sectional study done at a tertiary eye care centre in Hyderabad, between May to June 2021 and the study subjects were post COVID-19 patients with fungal invasion reporting to Government SD Eye Hospital and Government ENT Hospital Hyderabad, India. The patients were evaluated for associated co-morbidities, location of fungal infection, use of steroids, oxygen therapy usage and microbiologically identified the causative fungi. Descriptive analysis was done and data was presented as numbers and percentages were calculated.

Results: Overall, 470 cases of post COVID-19 suspected fungal invasion cases were referred from the Ophthalmology and Ear, Nose, and Throat (ENT) Departments, of which 287 (61.06%) cases were culture positive for various fungal elements. Fusarium spp. was predominantly seen in 165 (57.49%) cases followed by Aspergillus spp. in 71 (24.74%) cases, Mucor was isolated in 42 (14.64%) cases and other fungi like Candida spp. were isolated in 5 (1.74%) cases and Bipolaris spp. was seen in 4 (1.39%) cases. Pre-existing Diabetes Mellitus (DM) was present in 233 (81.18%) cases, cases, corticosteroid intake for the treatment of COVID-19 was recorded in 203 (70.73%) cases and oxygen therapy was administered in 160 (55.74%) cases.

Conclusion: As per the evaluation especially in post COVID-19 patients there seems to be a nexus between diabetes, imprudent use of steroids, decreased immune status, inappropriate use of oxygen therapy and invasion of fungi, therefore cautious and prudent use of the steroids and oxygen among the COVID-19 treatment protocol is advised.