Clinical study and outcome of rhino-orbital mucormycosis patients

Abstract

Objectives: To know the clinical presentation and outcome of rhino-orbital cerebral mucormycosis during the limited availability of facilities during the acute surge of COVID-19 pandemic. Method: We conducted a retrospective, non-interventional observational study on 55 patients with rhino-orbital cerebral mucormycosis. The study was undertaken based on the data available from case records who were diagnosed with rhino-orbital mucormycosis. Results: The mean age was 51.1 ± 11.3 years with a male preponderance of 72.7%. Fifty percent of patients were receiving treatment in mucormycosis ward. Concurrent ongoing COVID-19 with ROCM and past history of COVID-19 were present in 49.1% and 34.5%, respectively. History of steroid usage was seen in 81.81% of cases. Old case of diabetes and newly diagnosed diabetics were 47.3% and 32.7%, respectively. The most common clinical presentation was proptosis (65.5%), partial ophthalmoplegia (65.6%), and ptosis (50.9%), with highest number of patients involving orbital apex (34%). Injection amphotericin B, TRAMB, FESS, FESS with orbital debridement, and exenteration were done in 76.4%, 74.5%, 72.7%, 32.4%, and 1.8%, respectively. Conclusion: Mucormycosis should be suspected in patients with COVID-19 irrespective of severity with history of steroid usage associated with diabetes mellitus in second and third week. Our study signifies the importance of early diagnosis and prompt initiation of treatment with systemic, transcutaneous retrobulbar amphotericin B injection, and debridement of the orbit helps to salvage eye without requiring orbital exenteration. Even during scarcity of drugs and inadequately equipped health system, we were still able to salvage eyes in maximum number of patients.