{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:13:29Z","timestamp":1767852809735,"version":"3.49.0"},"reference-count":33,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","license":[{"start":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T00:00:00Z","timestamp":1693958400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>COVID-19\u2013associated rhino-orbital cerebral mucormycosis (ROCM) has a rapidly evolving course with high morbidity and mortality. We describe imaging features of COVID-19\u2013associated ROCM based on noncontrast computed tomography (NCCT). This retrospective single-center observational study included 50 patients with COVID-19 from January 1, 2021 to June 30, 2021 who subsequently developed ROCM confirmed by fungal culture studies. All patients underwent NCCT of the paranasal sinuses as the diagnostic workup. The involvement of the nasal cavity, paranasal sinuses, orbits, and intracranial cavity was identified and graded. The ethmoid sinuses were most commonly involved [right (<jats:italic>n<\/jats:italic> = 46 of 50) &gt; left (<jats:italic>n<\/jats:italic> = 45 of 50)], followed by the maxillary, sphenoid, and frontal sinuses. Thinning and erosions of the hard palate were noted in 18% of patients (<jats:italic>n<\/jats:italic> = 9), whereas 34% (<jats:italic>n<\/jats:italic> = 17) showed dehiscence of the lamina papyracea. Retromaxillary fat stranding was noted in 68% of patients (<jats:italic>n<\/jats:italic> = 34). Severe ethmoid sinusitis was associated significantly with ipsilateral pterygopalatine fossa involvement. The extraocular muscles were involved in 64% of patients (<jats:italic>n<\/jats:italic> = 32), with 84% (<jats:italic>n<\/jats:italic> = 42) showing orbital fat stranding. Proptosis of the affected eye was seen in 66% of patients, optic nerve involvement in 52%, and irregularity of globe contour in 12% (<jats:italic>n<\/jats:italic> = 6). The cavernous sinuses were affected in 10% of patients (<jats:italic>n<\/jats:italic> = 5), with three of them having temporal infarcts. COVID-19\u2013associated ROCM is an acute, invasive fungal disease characterized by multisinus involvement, often with orbital and intracranial extension. Bilateral involvement with rapid progression should alert one to underlying COVID-19 disease.<\/jats:p>","DOI":"10.4269\/ajtmh.22-0298","type":"journal-article","created":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T16:22:05Z","timestamp":1690215725000},"page":"600-607","source":"Crossref","is-referenced-by-count":2,"title":["Clinicoradiological Profile of COVID-19\u2013Associated Rhino-Orbital Cerebral Mucormycosis with a Focus on Computed Tomography: A Clinical Case Series and Review"],"prefix":"10.4269","volume":"109","author":[{"given":"Anuj","family":"Prabhakar","sequence":"first","affiliation":[{"name":"Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandeep","family":"Bansal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer","family":"Vyas","sequence":"additional","affiliation":[{"name":"Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikas","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sourabha","family":"Patro","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usha","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naresh","family":"Panda","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paramjeet","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashish","family":"Bhalla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goverdhan Dutt","family":"Puri","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chirag Kamal","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Division of Neuroimaging & Interventional Neuroradiology, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Mycopathologia","first-page":"1","article-title":"Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China","volume":"31","author":"Song","year":"2020"},{"key":"b2","series-title":"AJR Am J Roentgenol","first-page":"1431","article-title":"CT and MRI findings of invasive mucormycosis in the setting of COVID-19: experience from a single center in India","volume":"217","author":"Joshi","year":"2021"},{"key":"b3","series-title":"Am J Trop Med Hyg","first-page":"566","article-title":"Case report: rhino-orbital mucormycosis related to COVID-19: a case series exploring risk factors","volume":"106","author":"Aggarwal","year":"2021"},{"key":"b4","series-title":"Diabetes Metab Syndr","first-page":"102146","article-title":"Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India","volume":"15","author":"Singh","year":"2021"},{"key":"b5","series-title":"Microorganisms","first-page":"523","article-title":"Epidemiology of mucormycosis in India","volume":"9","author":"Prakash","year":"2021"},{"key":"b6","series-title":"Mycology","first-page":"75","article-title":"Antifungal-resistant Mucorales in different indoor environments","volume":"10","author":"Caetano","year":"2019"},{"key":"b7","series-title":"J Fungi (Basel)","first-page":"94","article-title":"Mucorales species and macrophages","volume":"6","author":"Nicol\u00e1s","year":"2020"},{"key":"b8","series-title":"Med Mycol","first-page":"567","article-title":"The environmental source of emerging Apophysomyces variabilis infection in India","volume":"54","author":"Prakash","year":"2016"},{"key":"b9","series-title":"Clin Otolaryngol","first-page":"1454","article-title":"A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis: has anything changed in the past 20 years?","volume":"43","author":"Vaughan","year":"2018"},{"key":"b10","series-title":"Microorganisms","first-page":"523","article-title":"Epidemiology of mucormycosis in India","volume":"9","author":"Prakash","year":"2021"},{"key":"b11","series-title":"Indian J Crit Care Med","first-page":"168","article-title":"Mucormycosis in a tertiary care center in South India: a 4-year experience","volume":"24","author":"Priya","year":"2020"},{"key":"b12","series-title":"Emerg Infect Dis","first-page":"2349","article-title":"Multicenter epidemiologic study of coronavirus disease\u2013associated mucormycosis, India","volume":"27","author":"Patel","year":"2021"},{"key":"b13","series-title":"Indian J Ophthalmol","first-page":"1670","article-title":"Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India: collaborative OPAI-IJO study on mucormycosis in COVID-19 (COSMIC), report 1","volume":"69","author":"Sen","year":"2021"},{"key":"b14","series-title":"Lancet Microbe","first-page":"e543","article-title":"The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries","volume":"3","author":"Hoenigl","year":"2022"},{"key":"b15","series-title":"J Fungi (Basel)","first-page":"88","article-title":"Autopsy proven pulmonary mucormycosis due to Rhizopus microsporus in a critically ill COVID-19 patient with underlying hematological malignancy","volume":"7","author":"Zurl","year":"2021"},{"key":"b16","series-title":"Mycopathologia","first-page":"289","article-title":"Coronavirus disease (Covid-19) associated mucormycosis (CAM): case report and systematic review of literature","volume":"186","author":"Garg","year":"2021"},{"key":"b17","series-title":"Am J Emerg Med","first-page":"264.e5","article-title":"Mucormycosis with orbital compartment syndrome in a patient with COVID-19","volume":"42","author":"Werthman-Ehrenreich","year":"2021"},{"key":"b18","series-title":"Emerg Infect Dis","first-page":"1454","article-title":"COVID-19-associated mold infection in critically ill patients, Chile","volume":"27","author":"Rabagliati","year":"2021"},{"key":"b19","series-title":"J Mycol Med","first-page":"101125","article-title":"Mucormycosis after coronavirus disease 2019 infection in a heart transplant recipient: case report and review of literature","volume":"31","author":"Khatri","year":"2021"},{"key":"b20","series-title":"Indian J Ophthalmol","first-page":"1002","article-title":"COVID-19 and orbital mucormycosis","volume":"69","author":"Sarkar","year":"2021"},{"key":"b21","series-title":"Arch Clin Cases.","first-page":"46","article-title":"A case report of COVID-19 associated pulmonary mucormycosis","volume":"7","author":"Khan","year":"2021"},{"key":"b22","series-title":"J Med Cases","first-page":"85","article-title":"Rhinocerebral mucormycosis and COVID-19 pneumonia","volume":"12","author":"Alekseyev","year":"2021"},{"key":"b23","series-title":"Int Forum Allergy Rhinol","first-page":"1029","article-title":"Fulminant mucormycosis complicating coronavirus disease 2019 (COVID-19)","volume":"11","author":"Karimi-Galougahi","year":"2021"},{"key":"b24","series-title":"Cureus","first-page":"e13163","article-title":"A case of fatal rhino-orbital mucormycosis associated with new onset diabetic ketoacidosis and COVID-19","volume":"13","author":"Waizel-Haiat","year":"2021"},{"key":"b25","series-title":"J Fungi (Basel)","first-page":"174","article-title":"A fatal case of Rhizopus azygosporus pneumonia following COVID-19","volume":"7","author":"Kanwar","year":"2021"},{"key":"b26","series-title":"Infect Dis Now","first-page":"633","article-title":"Mixed mold infection with Aspergillus fumigatus and Rhizopus microsporus in a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patient","volume":"51","author":"Bellanger","year":"2021"},{"key":"b27","series-title":"Ophthalmic Plast Reconstr Surg","first-page":"e40","article-title":"Acute invasive rhino-orbital mucormycosis in a patient with COVID-19-associated acute respiratory distress syndrome","volume":"37","author":"Mekonnen","year":"2021"},{"key":"b28","series-title":"Lancet Microbe","first-page":"e245","article-title":"Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study","volume":"1","author":"Hanley","year":"2020"},{"key":"b29","series-title":"J Fungi (Basel)","first-page":"298","article-title":"When uncontrolled diabetes mellitus and severe COVID-19 converge: the perfect storm for mucormycosis","volume":"7","author":"John","year":"2021"},{"key":"b30","series-title":"Diabetes Metab Syndr","first-page":"102267","article-title":"COVID-19 associated rhino-orbital-cerebral mucormycosis: an observational study from eastern India, with special emphasis on neurological spectrum","volume":"15","author":"Dubey","year":"2021"},{"key":"b31","series-title":"Clin Radiol","first-page":"784.e27","article-title":"Imaging findings using a combined MRI\/CT protocol to identify the \u201centire iceberg\u201d in post-COVID-19 mucormycosis presenting clinically as only \u201cthe tip.\u201d","volume":"76","author":"Desai","year":"2021"},{"key":"b32","series-title":"PLoS One","first-page":"e0160897","article-title":"Early differential diagnosis of rhino-orbito-cerebral mucormycosis and bacterial orbital cellulitis: based on computed tomography findings","volume":"11","author":"Son","year":"2016"},{"key":"b33","series-title":"Egypt J Radiol Nucl Med","first-page":"447","article-title":"Imaging features of rhinocerebral mucormycosis: a study of 43 patients","volume":"49","author":"Therakathu","year":"2018"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/3\/article-p600.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/3\/article-p600.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/3\/article-p600.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T13:47:57Z","timestamp":1694008077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/3\/article-p600.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,6]]},"references-count":33,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.22-0298","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,6]]}}}