Epidemiology, clinical profile, management and outcome in patients of post covid mucormycosis at a tertiary care center in eastern UP

Abstract

The second wave of covid 19 in our country has seen rhino orbital cerebral mucormycosis reach an epidemic level. It is an opportunistic fungal infection with high morbidity and mortality. This study aimed to determine the patient’s demographics, risk factors, symptoms and signs, treatment and the outcome at our tertiary care centre. In this retrospective observational study the case records of 43 patients with biopsy/culture proven invasive rhino-orbital mucormycosis who were admitted in the post covid phase between May 2021 and July 2021 were reviewed. : Mean age was 52.4 years with 65.11% of patients being male. 83.7% belonged to the rural background. 37 (86.05%) had history of diabetes while 25 (58.15%) used steroids and only 13 (30.23%) patients needed oxygen. Only 3 (6.97%) had RBS below 200mg/dl with 2 patient showing HbA1C level below 6.4. All patients had proptosis and ptosis while only 28 had chemosis and 26 had loss of vision. Chemosis showed significant association in our study with HbA1c with significant p value of 0.000126. and loss of vision showed a significant association with steroid use (p value 0.03) and oxygen requirement (p value 0.008). All the patients had involvement of orbit. Treatment included IV liposomal amphotericin B in all patients, Retrobulbar amphotericin B and endoscopic orbital debulking in. Significant improvement was seen in patients with stage >3b with Retrobulbar amphotericin B and orbital debulking. Patients with rhino orbital mucormycosis can be managed with orbital debulking with perilesional, intralesional and Retrobulbar amphotericin B with IV amphotericin B and functional endoscopic sinus surgery to avoid distressing surgery like exenteration.