Battling the emerging epidemic of rhino-orbital-cerebral mucormycosis (ROCM) in COVID-19 pandemic: an interventional study

• Published in: International ophthalmology Vol. 43; no. 5; pp. 1571 - 1580
• Main Authors: Gandhi, Aastha, Narula, Anurag, Chandra, Shreya, Agarwal, Dhwanee, Mehta, Anuj, Nayak, Shaktiprada, Arora, Sheetal, Capoor, Malini R.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.05.2023; Springer Nature B.V
• Subjects: Adult; Amphotericin B; Antifungal Agents - therapeutic use; Coronaviruses; COVID-19; COVID-19 - epidemiology; Debridement; Diabetes mellitus; Edema; Epidemics; Eye Diseases; Fungal infections; Health risks; Health services; Humans; India - epidemiology; Male; Medical prognosis; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; Mucormycosis; Mucormycosis - diagnosis; Mucormycosis - epidemiology; Mucormycosis - therapy; Ophthalmology; Orbital Diseases - diagnosis; Orbital Diseases - epidemiology; Orbital Diseases - therapy; Original Paper; Pandemics; Paranasal sinus; Patients; Posaconazole; Risk factors; Signs and symptoms; Superinfection; Survival; Viral diseases; India; COVID-19; ROCM; CAM
• ISSN: 1573-2630; 0165-5701; 1573-2630
• DOI: 10.1007/s10792-022-02556-3

Purpose The most recent challenge being faced by the healthcare system during the worldwide COVID-19 pandemic is increase in the incidence rate of coinfection or superinfection; one of the most fatal being mucormycosis. This study aimed to estimate the risk factors, symptoms and signs, treatment outcome and prognosis of COVID-19-associated mucormycosis (CAM) patients. Methods This is an interventional study of 35 patients diagnosed and managed as CAM at a tertiary care centre in New Delhi, India. Results The mean age of patients was 40.45 ± 6 years with a male preponderance. CAM did not affect healthy individuals; the major risk factors included diabetes in 65.7% and injudicious steroid use in 51.4% patients. Orbital/facial edema was the most common presenting symptom (25.7%) as well as sign (28.57%). 68.5% patients were stage 3 (involvement of orbit) at presentation; 33.3% showed medial wall involvement. Treatment included intravenous Amphotericin and oral Posaconazole in all patients, paranasal sinus (PNS) debridement in 94.2%, orbital exenteration was done in 8 patients. Adjuvant retrobulbar Amphotericin B injection was administered in 12 patients with radiological resolution seen in 50% after 1 cycle. In patients with Stage 4 disease who underwent exenteration along with PNS debridement, survival rate was 100% at 30 days, and disease reduction occurred in 87.5% patients ( P  < 0.01). Overall, 68.5% responded to therapy, 8.5% showed progression and mortality rate was 22.85%, at a mean follow up period of 59.5 days. Conclusion A multidisciplinary and aggressive approach is essential in the management of CAM patients.