RHINOORBITAL CEREBRAL MYCOSIS: A CASE SERIES OF NON-MUCORALES IN COVID PATIENTS

Introduction: Rhinocerebral mycoses are not only caused by Aspergillus spp. and Zygomycetes spp. but also can be associated with other rare species like Neurospora spp., Cladosporium spp, and Fusarium spp. Mucormycosis is caused due to immunocompromised state like patients with comorbidities like Diabetes Mellitus. Clinical symptoms of COVID and Mucormycosis are a critical and relentless situation without a saving grace even with treatment. Case series: We are reporting 3 patients with COVID-19 infection, who during the course of the treatment, developed rhino-orbital-cerebral mycosis including oral cavity involvement.Rhinocerebral mycosis along with Oral cavity involvement was diagnosed by radiological investigations and preliminary screening for fungal infection (KOH mount) in all three cases. Empirical treatment was started but patients were not responding to treatment. All patients succumbed even after debridement and Maxillectomy type crucial surgical procedures. On culture, rare species of fungi were isolated in all three cases which were identified with the help of a reference laboratory. Neurospora is considered nonpathogenic to humans. Cladosporium is a dematiaceous fungus found in soil in all climates, associated with disseminated or cerebral infections; and Fusarium though considered a saprophytic colonizer of skin and respiratory mucosa along with other bacteria, it is a common cause of mycotic keratitis worldwide. Conclusion: Immune system modifications due to COVID-19 with/without other risk factors result in fungal co-infections proving to be fatal for the patients. It is vital to be aware that COVID-19 patients, particularly those who are critically ill, may acquire secondary fungal infections and early detection is critical