key: cord-0710965-r6a51mwc authors: Leal-Buitrago, Anderson; Mondragon-Ángulo, Diver; Cely-Aldana, Nicolás Alberto; Ortega-Sierra, Michael Gregorio; Bolaño-Romero, Maria Paz title: Letter: Spectrum of hospitalized NeuroCOVID diagnoses from a tertiary care neurology centre in Eastern India date: 2022-01-06 journal: J Clin Neurosci DOI: 10.1016/j.jocn.2021.12.032 sha: e99f153349b7ca88976d26e6ab7d85e4f9e8cbad doc_id: 710965 cord_uid: r6a51mwc nan about this disease is that it can go unnoticed and present in advanced stages, compromising a large number of organs and structures [13] . Interestingly, however, there are cases reports and case series that show that this condition can develop even in those before 21 days (theoretically during the acute phase of COVID-19) [10] [11] [12] [13] . But it should be clarified that there are still no precise cut-off scores for the time between the acute phase transition and post-COVID phase, which is a potential bias in the characterization of these patients [9] . The subtypes of mucormycosis with invasion to the central nervous system are cerebral or rhino-orbito-cerebral mucormycosis (even more extensive) [13] . In low-and middle-income Asian countries, where there are difficulties in the management of environmental sanitation, overcrowdingand high rates of poverty, it has been reported an elevated risk of developing this condition in patients affected by COVID-19, especially in those groups that additionally have pathological antecedents such as Diabetes Mellitus and Cancer [11, 13, 14] . Taking into account the heterogeneity in the times of presentation of this condition, it is necessary to define whether rhino-orbito-cerebral mucormycosis is a manifestation of the acute phase of COVID-19, associated with the immune mechanisms involved in the neuroinflammation caused by the neurotropism of SARS-Cov-2, or typical of the post-COVID-19 neurological syndrome, where there is therapeutic remission and risk of complications. This discussion becomes relevant due to the new peaks of COVID-19 cases in the world in the last weeks (November-December 2021) [15] , and the factors associated with the presentation of rhino-orbito-cerebral mucormycosis [16, 17] , such as the management of the acute phase of COVID-19 with corticosteroids and antibiotics, the high prevalence of diabetic patients or patients with endocrine disorders with off-target hyperglycemia [10] [11] [12] [13] [14] 16, 17] , where an increase in the incidence of this complication, which entails high health costs during management and rehabilitation, morbidity and mortality, is expected. We consider it essential to include cerebral and rhino-orbitocerebral mucormycosis within the spectrum of NeuroCOVID-19, to propose prospective multicenter studies with large cohorts, which will allow us to determine associated factors, safe and effective management, prognosis and real prevalence. It is possible that some cases of bacterial or viral neuroinfection are confused with cerebral mucormycosis, and due to the public health calamity and the management of the flow of patients and deaths, the causes of deaths are not examined in detail. Other strategies, such as the creation of specialized public health units specifically for the strict surveillance of this disease, are not only necessary in those countries where there have been a greater number of reports, but also in isolated cases that may cause an outbreak. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 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The author(s) received no financial support for the research, authorship, and/or publication of this article.