{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:04:45Z","timestamp":1790899485829,"version":"4.1.0"},"reference-count":66,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19\u2013associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor\/comorbidity, intervention, and outcome. \u201cR-metafor package\u201d was used for analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases.\n                      <jats:italic toggle=\"yes\">Rhizopus<\/jats:italic>\n                      was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041\u20130.544,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212\u20134.087,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205\u20130.403) despite treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijp.ijp_839_21","type":"journal-article","created":{"date-parts":[[2021,12,29]],"date-time":"2021-12-29T23:51:20Z","timestamp":1640821880000},"page":"499-510","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":52,"title":["COVID-19\u2013Associated Rhino-Orbital-Cerebral Mucormycosis"],"prefix":"10.4103","volume":"53","author":[{"given":"Anusuya","family":"Bhattacharyya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phulen","family":"Sarma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hardeep","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subodh","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaimini","family":"Bhattacharyya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Prajapat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Prakash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dibbanti Harikrishna","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasad","family":"Thota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Bansal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhaswati Sharma","family":"Gautam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bikash","family":"Medhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-11-20240903","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jhin.2021.01.027","article-title":"Clinical characteristics and risk factors for the isolation of multi-drug-resistant Gram-negative bacteria from critically ill patients with COVID-19","volume":"110","author":"Baiou","year":"2021","journal-title":"J Hosp Infect"},{"key":"R2-11-20240903","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.cmi.2020.10.021","article-title":"Secondary infections in patients hospitalized with COVID-19: Incidence and predictive factors","volume":"27","author":"Ripa","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"R3-11-20240903","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.jinf.2020.09.024","article-title":"Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals","volume":"81","author":"Seaton","year":"2020","journal-title":"J Infect"},{"key":"R4-11-20240903","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1111\/myc.13225","article-title":"Increased incidence of candidemia in a tertiary care hospital with the COVID-19 pandemic","volume":"64","author":"Nucci","year":"2021","journal-title":"Mycoses"},{"key":"R5-11-20240903","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1164\/rccm.202004-1038LE","article-title":"COVID-19-associated pulmonary aspergillosis","volume":"202","author":"van Arkel","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"R6-11-20240903","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1007\/s12663-021-01532-1","article-title":"SARS-CoV-2, uncontrolled diabetes and corticosteroids \u2013 An unholy trinity in invasive fungal infections of the maxillofacial region? 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