Role of Inflammatory Markers as Prognostic Indicators in Treatment of Mucormycosis

Main Article Content

Pruthvi RajS
Ashwini Godse
Architha Menon P
Deepika T M
Ravishankar C

Abstract

Introduction: Mucormycosis is opportunistic fungal infection characterized by extensive inflammation, necrosis and infarction of the involved tissues. It is associated with rise in levels of inflammatory markers [Erythrocyte sedimentation rate (ESR) , C-reactive protein (CRP)]. This study was done to know the role of ESR, CRP as prognostic indicators in the treatment of covid-19 associated mucormycosis (CAM).

Materials and Methods: : A retrospective descriptive study was conducted between May 2021 and December 2021 at a tertiary centre. 315 patients with post-covid ROCM (Rhino-orbito-cerebral mucormycosis) were included in study. ESR and CRP were sent for all patients at the time of admission. Postoperatively the same were  repeated on post-op (POD) day 7, day 14, and day 30 during follow-up.


Results: 243 (77.14%) patients were male and 72 (22.86%) were female. 6 patients with stage IV ROCM had recurrence of the disease in the postoperative period. Mean  ESR values in these patients at the time of admission, POD-7, 14, 30 were 98.17, 68.17, 44.00, 80.33 respectively. Mean CRP values in these patients at the time of admission, POD-7, 14, 30 were 58.50, 48.17, 26.33,37.83 respectively.


Conclusion: Serial measurements of inflammatory markers (ESR, CRP) levels helps in the diagnosis and prognostication of  ROCM along with clinical evaluation and imaging.

Article Details

How to Cite
1.
RajS P, Godse A, Menon P A, T M D, C R. Role of Inflammatory Markers as Prognostic Indicators in Treatment of Mucormycosis . BJOHNS [Internet]. 2023Mar.31 [cited 2024Nov.21];30(2):227-32. Available from: https://bjohns.in/journal3/index.php/bjohns/article/view/760
Section
Main article
Author Biographies

Pruthvi RajS, Shri Atal Bihari Vajpayee Medical College & Research Institute

Assistant Professor, Department of Otorhinolaryngology, 

Ashwini Godse, Bangalore Medical College and Research Institute, Bangalore

Assistant Professor, Department of Otorhinolaryngology, 

Architha Menon P, Shri Atal Bihari Vajpayee Medical College and Research Institute, Bangalore.

Assistant Professor, Department of Otorhinolaryngology, 

Deepika T M, Bangalore Medical College and Research Institute, Bangalore.

Junior Resident, Department of Otorhinolaryngology, 

Ravishankar C, Bangalore Medical College and Research Institute, Bangalore

Professor, Department of Otorhinolaryngology, 

References

Werthman-Ehrenreich A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med. 2021 Apr;42:264.e5-264.e8. doi: 10.1016/j.ajem.2020.09.032

Prakash H, Chakrabarti A. Epidemiology of Mucormycosis in India. Microorganisms. 2021 Mar4;9(3):523.doi:10.3390/microorganisms9030523

Dyer O.Covid-19:India sees record deaths as “black fungus” spreads fear.BMJ 2021;373:n1238 http://dx.doi.org/10.1136/bmj.n1238

Radha Sharma / TNN / Updated: May 21 2021. Gujarat: With scarcity, fungus experts

suggest alternative drug: Ahmedabad News - Times of India [Internet]. The Times of India.

TOI; 2021 [cited 2022Nov19]. Available from:

https://timesofindia.indiatimes.com/city/ahmedabad/with-scarcity-fungus-experts-suggest-

alternative-drug/articleshow/82813984.cms

Mehta S, Pandey A.Rhino-Orbital Mucormycosis Associated With COVID-19. 2020 september 30;Cureus 12(9): e10726. doi:10.7759/cureus.10726

Prakash H, Ghosh AK, Rudramurthy SM, Singh P, Xess I, Savio J, Pamidimukkala U, Jillwin J, Varma S, Das A, Panda NK, Singh S, Bal A, Chakrabarti A. A prospective multicenter study on mucormycosis in India: Epidemiology, diagnosis, and treatment. Med Mycol. 2019 Jun 1;57(4):395-402. doi: 10.1093/mmy/myy060

Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE etal.Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020 Sep 12;71(6):1367-1376. doi: 10.1093/cid/ciz1008

Honavar SG. Code Mucor: Guidelines for the Diagnosis, Staging and Management of Rhino-Orbito-Cerebral Mucormycosis in the Setting of COVID-19. Indian J Ophthalmol. 2021 Jun;69(6):1361-1365. doi: 10.4103/ijo.IJO_1165_21

Tishkowski K, Gupta V. Erythrocyte Sedimentation Rate. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557485/

Abramson N. Rouleaux formation. Blood. 2006 Jun 1;107(11):4205

Lelubre C, Anselin S, Zouaoui Boudjeltia K, Biston P, Piagnerelli M. Interpretation of C-reactive protein concentrations in critically ill patients. Biomed Res Int. 2013;2013:124021. doi: 10.1155/2013/124021

Amancio RT, Japiassu AM, Gomes RN, Mesquita EC, Assis EF, Medeiros DM, et al. (2013) The Innate Immune Response in HIV/AIDS Septic Shock Patients: A Comparative Study. PLoS ONE 8(7): e68730. https://doi.org/10.1371/journal.pone.0068730

Kostiala I. C-reactive protein response induced by fungal infections. J Infect. 1984 May;8(3):212-20. doi: 10.1016/s0163-4453(84)93883-0

Marková M, Brodská H, Malíčková K, Válková V, Cetkovský P, Kolář M, Haluzík M. Substantially elevated C-reactive protein (CRP), together with low levels of procalcitonin (PCT), contributes to diagnosis of fungal infection in immunocompromised patients. Support Care Cancer. 2013 Oct;21(10):2733-42. doi: 10.1007/s00520-013-1844-1

Cho HJ, Jang MS, Hong SD, Chung SK, Kim HY, Dhong HJ. Prognostic factors for survival in patients with acute invasive fungal rhinosinusitis. Am J Rhinol Allergy. 2015 Jan-Feb;29(1):48-53. doi: 10.2500/ajra.2015.29.4115

Catanzaro M, Fagiani F, Racchi M, Corsini E, Govoni S, Lanni C. Immune response in COVID-19: addressing a pharmacological challenge by targeting pathways triggered by SARS-CoV-2. Signal Transduct Target Ther. 2020 May 29;5(1):84. doi: 10.1038/s41392-020-0191-1.