Original Research Paper

Clinical Characteristics, Management And Outcome Of Covid-19 Associated Rhino-orbital-cerebral-mucormycosis Patients During Second Wave Of Covid-19

Abstract :

Purpose: Covid-19-associated Rhino-orbital-cerebral Mucormycosis (ROCM) has reached epidemic proportion during Indias second wave of Covid-19 pandemic, with several risk factors being implicated in its pathogenesis. The present study aimed to document cases of rhino-orbital Mucormycosis and to evaluate risk factors including comorbidities, clinical characteristics, diagnosis, management and outcome at Tertiary care centre during Covid-19 (2021) pandemic. Methods: It is retrospective study, carried out at tertiary care centre from April 2021 to September 2021. 42 patients of biopsy proven Mucormycosis were included in the study. These patients records were reviewed from hospital data. All patients were subjected to complete ophthalmological, ENT examination and imaging studies. Orbital staging was done. Each case was treated by multidisciplinary approach with Functional Endoscopic Sinus Surgery (FESS) and intravenous amphotericin B(AMB). Retrobulbar liposomal amphotericin-B and Exenteration was done whenever indicated. A minimum 60 day follow up period was attributed from the day of discharge to all study patients. Statistical analysis was done using Chi square test. A P value 0.05 was taken as significant.Results: Total 42 patients of ROCM were documented. Most of the cases showed onset of symptoms of ROCM between day 20 and day 30 from the diagnosis of Covid-19. The mean age was 50.48 years with a male preponderance (82.9%). A total of 95.1% of patients had diabetes (30) and Covid-19 positivity (40). Concurrent steroid use was seen in 83.3% where 73.1% of patients had received oxygen support during Covid-19 infection. The most common ophthalmologic presentation was orbital/facial oedema (33) and pain, diminution of vision (24) and ophthalmoplegia (26). Direct nasal endoscopy and biopsy was done to establish diagnosis. The most common imaging findings were orbital cellulitis (30), extra ocular muscle involvement (26) and pansinusitis (33). Orbit was involved in 58.5% of patients, with stage ranging from 2a-4d. All patients were treated with FESS and intravenous AMB. Retrobulbar AMB was given in 11 patients. Exenteration was done in (n = 4) 10.5% of cases. 41 patients recovered and mortality was seen in 1 patient.Conclusion: Corticosteroids and DM are the most important predisposing factors in the development of Covid-19-associated ROCM. Covid-19 patients must be followed up beyond recovery. Awareness regarding red flag symptoms and high index of clinical suspicion in Covid-19 recovered patients with prompt diagnosis and early initiation of treatment are essential for successful outcome with less mortality.

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