Study of the association of COVID-19 infection in the treatment outcomes in patients of rhino orbital Mucormycosis presenting to a tertiary care center

Background: During the second wave of COVID-19 starting in January 2021, an increase in Mucormycosis infection was recorded in various Indian states. With the aim of identifying the contribution or relationship of covid 19 infection in the incidence, severity and treatment outcomes of Mucormycosis during the pandemic, this retrospective observational research study was conducted.
Method: 113 people with rhino orbital Mucormycosis were included in the retrospective observational investigation. Based off the past medical records, basic demographic information was gathered. In order to evaluate the association between covid 19 infection and Mucormycosis, patient histories of COVID infection, steroid usage during therapy, and oxygen consumption were collected. Positive RTPCR and/or Positive Rapid antigen tests were used to diagnose active covid positive status. Using a nasal swab/tissue KOH mount, nasal endoscopy with biopsy, and radiographic tests to determine the extent, the diagnosis of Mucormycosis infection was established. A multidisciplinary strategy was used to handle the patients in collaboration with the departments of medicine, ophthalmology, neurosurgery, and OMFS. Individuals with uncontrolled diabetes received insulin and/or oral medications, and BSL was aggressively managed. Each patient received 3 to 5 mg/kg body weight/day of intravenous amphotericin B, adjusted according to renal function, medication availability, and the severity of the illness. Individuals who underwent endoscopic debridement using a modified Denker’s technique or medial maxillectomy had disease that was restricted to the nose and paranasal sinuses but did not affect the palate or orbit. Whole maxillectomy was performed on patients who had palatal involvement. Most individuals with orbital involvement underwent a limited procedure for orbital decompression or rarely an exenteration/evisceration procedure.
Results: Out of 113 patients, 26 (23%) had a Covid positive status at the point they were initially assessed, 56 (49.55%) had confirmed prior h/o covid infection, 31 (27.4%) had no proven h/o covid 19 infection, and 62 (54%) had h/o usage of steroids to treat their covid infection. Of of the 113 patients, 90 patients underwent combination medicinal and surgical therapy, which comprised of administering injectable Amphotericin B and performing endoscopic endonasal debridement of the afflicted areas. 23 patients (20%) were left unoperated, largely as a result of problems arising from active COVID-19 infection (15 patients, 13%) or severe cerebral involvement (6 patients), as well as the refusal of two patients undergo surgery. Out of the 113 patients who received treatment, 24 (21.23%) died from the disease, leaving 89 (78.76%) surviving. Of the survivors, 27 (23.89%) had some form of disability at the end of the treatment period (in form of cranial nerve palsies, permanent loss of vision, palatal perforations and in 1 case a patient had an open left maxillary and nasal cavity which was referred to plastic surgeon for revision surgery and rehabilitation and 62 patients (54.86%) healed fully without any sequelae. Those who received combination therapy, which included both surgery and IV amphotericin, fared far better (84 in 90 survived 93%) than those who had only IV amphotericin B therapy (5 in 23 survived 22%).
Conclusion: Covid positive status was linked to higher disease severity, increased morbidity, and increased mortality after therapy. There were several individuals with Mucormycosis who had no prior history of COVID. Increased mortality was linked to uncontrolled diabetes, Rhino orbital cerebral expansion, and concurrent covid positive status. Our study shows that invasive Mucormycosis can have a positive clinical result with immediate vigorous surgical debridement and antifungal drug administration.