Trends in Clinical and Medical Sciences
Special issue: Recent developments of medical and surgical research (2023), pp. 539 – 548
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-rdmsr075
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-rdmsr075
Clinical profile of rhino-orbito-cerebral mucormycosis cases during second wave of COVID-19 pandemic presenting to tertiary care Hospital-A retrospective study
Dorkar Shashikant Narayan\(^{1,*}\), Nilakhe Sachin Sharad\(^{1}\) and Panchal Shivani Bhagwatkumar\(^{1}\)
\(^{1}\) Department of Otorhinolaryngology, Bharati Hospital Medical College & Hospital, Bharati Vidyapeeth (Deemed To Be University), Sangli, Maharashtra, India.
Correspondence should be addressed to Dorkar Shashikant Narayan at shashikantdorkar@yahoo.in
Copyright © 2023 Dorkar Shashikant Narayan, Nilakhe Sachin Sharad and Panchal Shivani Bhagwatkumar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: March 7, 2023 – Accepted: May 20, 2023 – Published: May 28, 2023
Abstract
Background: A retrospective study of records of 113 patients presenting to a tertiary care hospital during the 2nd wave of the COVID-19 pandemic was carried out with an aim to study the clinical profile of rhinoorbitocerebral mucormycosis (ROCM) patients.
Results: Out of 113 patients, 80 were males and 33 were females with a male-to-female ratio of 2.42:1. The most common age group affected was 51-60 years for both males (n=24) and females (n=37). The most common clinical presentation was headache (n=80) followed by ptosis, proptosis, and ophthalmoplegia (n=77). Based on radiology, all patients had nose and paranasal sinuses involvement, 71.68% had orbital involvement, and 13.27% had intracranial involvement. The most common extrasinus involvement was maxillofacial soft tissue. 89% were either COVID positive or COVID like on HRCT or post-COVID. Only 11% had no history of COVID or COVID like on HRCT (High Resolution Computed Tomography). 83 were diabetic, 55 had kidney disease, and 38 were hypertensive. 45.13% of patients had a history of steroid use, 21.23% had used oxygen, and 4.42% had a history of ventilator support.
Conclusion: Mucormycosis is a multi-system fungal infection with a significant surge in incidence in the second wave COVID era, which suggests a possible correlation of COVID infection with mucor. Uncontrolled diabetes is the commonest risk factor for mucor infection. The disease primarily involves the nose and paranasal sinuses, extending to the surrounding areas. MRI with contrast is the gold standard diagnostic modality to define the disease extent. Retromaxillary fissure involvement is an important cause for ophthalmoplegia in the majority of patients. Limited endoscopic orbital debridement with preservation of the globe avoids gross disfigurement and mental trauma to the patients. Early diagnosis with aggressive anti-fungal treatment combined with surgical debridement results in improving overall prognosis and survival in post-COVID mucormycosis patients.
Results: Out of 113 patients, 80 were males and 33 were females with a male-to-female ratio of 2.42:1. The most common age group affected was 51-60 years for both males (n=24) and females (n=37). The most common clinical presentation was headache (n=80) followed by ptosis, proptosis, and ophthalmoplegia (n=77). Based on radiology, all patients had nose and paranasal sinuses involvement, 71.68% had orbital involvement, and 13.27% had intracranial involvement. The most common extrasinus involvement was maxillofacial soft tissue. 89% were either COVID positive or COVID like on HRCT or post-COVID. Only 11% had no history of COVID or COVID like on HRCT (High Resolution Computed Tomography). 83 were diabetic, 55 had kidney disease, and 38 were hypertensive. 45.13% of patients had a history of steroid use, 21.23% had used oxygen, and 4.42% had a history of ventilator support.
Conclusion: Mucormycosis is a multi-system fungal infection with a significant surge in incidence in the second wave COVID era, which suggests a possible correlation of COVID infection with mucor. Uncontrolled diabetes is the commonest risk factor for mucor infection. The disease primarily involves the nose and paranasal sinuses, extending to the surrounding areas. MRI with contrast is the gold standard diagnostic modality to define the disease extent. Retromaxillary fissure involvement is an important cause for ophthalmoplegia in the majority of patients. Limited endoscopic orbital debridement with preservation of the globe avoids gross disfigurement and mental trauma to the patients. Early diagnosis with aggressive anti-fungal treatment combined with surgical debridement results in improving overall prognosis and survival in post-COVID mucormycosis patients.
Keywords:
COVID-19 pandemic; Rhinoorbitocerebral mucormycosis.