Rhino-Orbital-Cerebral Mucormycosis: Clinico-Epidemiologic Study in a Regional Centre in Eastern India during the Second Wave of COVID-19 Pandemic
Main Article Content
Abstract
Introduction
Rhino-orbital -cerebral mucormycosis (ROCM), a life-threatening acute fungal rhinosinusitis, has recently been reported in increasing numbers in post-COVID patients in the backdrop of uncontrolled hyperglycemia. We present our on-going experience with these patients.
Materials and Methods
A descriptive longitudinal study involving forty-three ROCM patients, during the 2nd wave of COVID -19, are presented here to discuss the epidemiology, clinical features, management approaches and outcomes.
Results
Commoner in males (65%), most ROCM patients belonged to lower socio-economic status and 41-50 years age group. Eighty six percent patients were known diabetics and confirmed COVID-19 illness were present in and 53% patients. Advanced disease (Stage-3&4) was found in 54% of patients at presentation. Diagnosis was confirmed by fungal culture and histopathological evidence of tissue invasion. All patients received injection Amphotericin B and undergone surgical debridement (endoscopic or external approach). Seventy two percent patients were discharged on oral antifungal post -debridement, 28% patients expired during course of treatment.
Conclusion
ROCM led to significant morbidity and mortality in post COVID patients due to its aggressive nature, late presentation and limited guidelines on management protocol. Early diagnosis in patients presented with suggestive background and a multidisciplinary team management approach is crucial. Randomized control trials on efficacy of various treatment modalities with duration of antifungal treatment will help in better management of these patients.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Prakash H, Chakrabarti A. Epidemiology of Mucormycosis in India. Microorganisms. 2021; 9:523. Published 2021 Mar 4
Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021; 15:102146. doi: 10.1016/j.dsx.2021.05.019
Hernández JL, Buckley CJ. Mucormycosis In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 26, 2021
Saleem S M, Jan S S, Modified Kuppuswamy socioeconomic scale updated for the year 2021. Indian J Forensic Community Med 2021;8:1-3
Spellberg B, Ibrahim Ashraf S. Mucormycosis Harrison’s Principles of Internal Medicine,20e, Part 5; Chapter 213.p1537-41
Honavar SG. Rhino-orbito-cerebral mucormycosis – Guidelines for diagnosis, staging, and management. Indian J Ophthalmol. 2021;69
Upadhyay S, Dolci RL, Buohliqah L, Prevedello DM, Otto BA, Carrau RL. Endoscopic endonasal anterior maxillotomy. Laryngoscope 2015; 125:2668-71
Peterson KL, Wang M, Canalis RF, Abemayor E. Rhinocerebralmucormycosis: evolution of the disease and treatment options. Laryngoscope. 1997 Jul; 107(7):855-62
Abdollahi A, Shokohi T, Amirrajab N, et al. Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral mucormycosis- A retrospective analysis. Curr Med Mycol. 2016;2:15-23
Nehara HR, Puri I, Singhal V, et al. Rhinocerebral mucormycosis in COVID-19 patient with diabetes a deadly trio: Case series from the north-western part of India. Indian J Med Microbiol. 2021
Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19: e405-e421.