Rhino-orbital-cerebral mucormycosis associated with COVID-19 and mortality-related factors: a systematic review

Abstract

Introduction and Objective: Rhino-orbito-cerebral mucormycosis (ROCM) emerged as a severe complication during the COVID-19 pandemic, particularly in patients with poorly controlled diabetes or those treated with corticosteroids. This rapidly progressing infection presents high mortality rates and significant challenges in diagnosis and management. The objective of this systematic review was to analyze the clinical factors associated with mortality in patients with COVID-19-related ROCM. Methods: A systematic review was conducted following PRISMA guidelines, using databases such as Scopus, PUBMED, and ScienceDirect. Original studies published in English between December 2019 and December 2024 were included. Study quality was assessed using the Newcastle-Ottawa Scale. A descriptive analysis was performed based on odds ratios (OR), relative risks (RR), and 95 % confidence intervals (95 % CI) reported in the included studies. Associations were considered statistically significant when the confidence interval did not include the null value. A meta-analysis was not performed due to methodological heterogeneity among the studies. Results: Sixteen studies were identified, reporting mortality rates ranging from 4.8 % to 66.7 %. Major risk factors associated with mortality included diabetes mellitus (67.64 %–95.33 %), corticosteroid use (72.3 %–74 %), advanced age, and intracranial or orbital extension of the infection. Early diagnosis and combined treatment (surgical and medical) significantly improved survival rates. Discussion: COVID-19-associated ROCM is strongly linked to diabetes and corticosteroid use, both of which impair immune response and facilitate fungal infection. Infection extension to the central nervous system or orbits markedly increased mortality. The studies emphasized the importance of a multidisciplinary approach and aggressive management to improve patient outcomes. Conclusions: COVID-19-related ROCM is a life-threatening complication with high mortality, primarily associated with diabetes, corticosteroid use, and infection spread. Early diagnosis and combined therapeutic strategies are essential to improve survival. Future research should focus on prospective, multicenter studies to optimize prevention and management strategies.
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