Tracing, Tracking and Treating COVID-19 Associated Rhino-Orbito Cerebral Mucormycosis (ROCM)

Vijay Bidkar; B H Shrikrishna; Sandeep Dabhekar; Kiran Kumar Prathipati; Prashant P Joshi; Rasika Gadkari; Meena Mishra; Kalaiselvi Selvaraj; Chetana Ratnaparakhi; Avinash Prakash; Rajesh Pattebahadur; Anand Chellapan; Raghunath Shanbag

doi:10.1007/s12070-022-03134-w

Tracing, Tracking and Treating COVID-19 Associated Rhino-Orbito Cerebral Mucormycosis (ROCM)

Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):3304-3312. doi: 10.1007/s12070-022-03134-w. Epub 2022 Aug 18.

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Maharashtra India.
² Department of General Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra India.
³ Department of Pathology, All India Institute of Medical Sciences, Nagpur, Maharashtra India.
⁴ Department of Microbiology, All India Institute of Medical Sciences, Nagpur, Maharashtra India.
⁵ Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra India.
⁶ Department of Radio-Diagnosis, All India Institute of Medical Sciences, Nagpur, Maharashtra India.
⁷ Department of Anaesthesiology, All India Institute of Medical Sciences, Nagpur, Maharashtra India.
⁸ Department of Ophthalmology, All India Institute of Medical Sciences, Nagpur, Maharashtra India.
⁹ Department of Nephrology, All India Institute of Medical Sciences, Nagpur, Maharashtra India.
¹⁰ Department of Otorhinolaryngology-Head and Neck Surgery, SDM College Medical Sciences & Hospital, Dharwad, Karnataka India.

Abstract

Surge in the number of mucormycosis cases following second wave of coronavirus disease-19 (COVID-19) infection posed several diagnostic and prognostic challenges. This study was aimed to describe clinical, diagnostic features and survival outcomes among patients of mucormycosis in post COVID-19 context. Retrospective chart review. This study included 44 COVID-19 positive screened cases who presented with clinical features suggestive of mucormycosis. Demography, clinical profile, diagnostic findings, and the treatment outcome are studied. Medical and surgical outcomes are summarised as frequencies and percentages. The reliability of microbiological, and radiological findings against the pathological findings was analyzed using Kappa statistics (k). Based on constellation of microbiological, pathological and radiological findings 28 cases (63%) confirmed with mucormycosis infection. The mean (SD) age was 54.9 (12.9) years and two-third were males. The majority (90%) of cases presented with the feature of facial swelling, headache nasal blockade. Inpatient care for treatment of COVID-19 was recorded in 33 (75%). Diabetes mellitus was the commonest comorbidity in 27 (61.4%), 38 (86.4%) cases were treated by steroids and 30 (68.2%) were given oxygen therapy. There is a strong agreement (k = 0.83) between pathological and microbiological investigations. In thirty-eight cases (86.3%) remission was achieved when assessed after 8 weeks. Of the 44 cases, four patients died. The results of the current study suggest that the disease residues and/or recurrences in critical areas are frequent in mucormycosis. However, using the strategy of screening at risk patients, diagnosing, treating them with combination of antifungals, surgical debridement, and timely follow up may help in improving outcomes as compared to pre COVID-19 era.

Keywords: Amphotericin-B; Corticosteroids; Diabetes mellitus; Endoscopic sinus surgery; Maxillectomy; Mucormycosis and covid-19.

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