Collaborative Study of COVID-19 Associated Rhino- Orbital-Cerebral Mucormycosis in Iran (CA-ROCM-IR): A Preliminary Report
Authors: Eshraghi Bahram , Khademi Behzad , Mirmohammadkhani Majid , Khataminia Gholamreza , Ghahvehchian Hossein , Kiarudi Mohammad Yaser , Nabie Reza , Parandin Mohammadmehdi , Boroumand Paria Ghasemi , Mohammadi Rasoul , Zia Zahra , Karamirad Soroush , Jafarpour Soheyla , Fakoor Mostafa , Varshochi Mojtaba , Shahraki Kourosh , Memarzadeh Mohammad , Janipour Masoud , Rad Atefe Mahdian , Kashkouli Mohsen Bahmani , Shekarchian Farid , Manouchehri Vahideh , Khosravi Abbas , Hosseini Nastaran-Sadat , Shahir Abazar , Sajjadi S. Mohammad Javad , Razavi Mohammad Etezad , Abounoori Mahdi , Ebrahimi Fatemeh , Noorshargh Pegah , Pourazizi Mohsen , Forouhari Ali 
Published: January 2023

The outbreak of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) through the latest waves of the pandemic in several countries gathered attention to this rare fungal infection. This prospective observational study aims to evaluate the demographic and medical profile, clinical signs and symptoms (with a special focus on ophthalmic findings), imaging features, and the outcome of CA-ROCM patients. The collaborative study of COVID-19 Associated Rhino-Orbital-Cerebral Mucormycosis in Iran (CA-ROCM-IR) has been conducted in 8 tertiary referral ophthalmology centers among different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination, and underwent standard accepted treatment strategy based on the disease stage. The present report is the preliminary results of this project study. Two hundred seventy-four CA-ROCM patients, including 150 males (54.7%), who had a mean age of 56.8 ± 12.44 years, were enrolled. Diabetes mellitus was the most prevalent (82.8%) medical disease among the patients. Supplemental oxygen administration and corticosteroid use due to COVID-19 were present in a large proportion of the patients (68.2%, and 73.7% respectively). The most common primary complaints were facial pain (47.4%), facial swelling (38.3%), and nasal discharge (32.5%). Ptosis (58%), periorbital swelling (46%), and nasal congestion (40.5%) were common signs and symptoms among CA-ROCM patients. A majority of the patients (80.3%) were diagnosed at stage 3 or higher of ROCM and the rate of ocular involvement in whom was 92.3%. The most affected paranasal sinus was the ethmoid sinus (75.2%), followed by the maxillary sinus (70.8%). A total of 30 patients (10.9%) had expired before discharge from hospitals. Patients with a history of cigarette smoking (OR = 7.25), ICU admission (OR = 87.36), higher stage of the ROCM (OR = 4.22), receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (TRAMB) (OR = 4.20), and bilateral ocular involvement (OR = 2.94) had upper odds for death before discharge from hospital. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (OR = 0.058, P = 0.006). Also, GEE analysis showed statistically significant higher mean LogMAR visual acuity score among expired patients (3.71, 95% CI: 3.04–4.38) compared to patients who were discharged from hospitals (2.42, 95% CI: 2.16–2.68) (P < 0.001).