RHINO ORBITO CEREBRAL MUCORMYCOSIS (ROCM) - A Retrospective analysis of 31 patients

Introduction - Mucormycosis is known to be an aggressive and potentially fatal disease caused by fungi that belong to the order mucorales and is known to occur in all ages and in both gender when associated with a predisposing risk factor of which the commonest being Diabetes mellitus. Rhino orbito cerebral mucormycosis(ROCM) is the common form of mucormycosis. We, in this study, have attempted to report the clinical profile, management and outcome of patients diagnosed to have Rhino orbito cerebral mucormycosis. Study design - Retrospective chart review of in-patients diagnosed to have Rhino orbito cerebral mucormycosis( ROCM) during the period of January 2005 to June, 2012 in a tertiary care hospital in South India. Results - 31 patients diagnosed to have ROCM were included in the study. Uncontrolled sugars in diabetic patients were the most common co morbid risk factor. Nasal discharge was the predominant symptom, followed by nasal obstruction. Facial swelling was the most earliest and common presenting sign. The most common fungal species isolated was Rhizopus arrhizus. Sino-nasal involvement was noted in 25 percentage of cases, Rhino-orbital disease in 32 percentage of cases and Rhino-orbito-cerebral disease in 43 percentage of cases. 39 of patients underwent orbital exenteration, 29 of patients needed revision surgery. Clinical Outcome showed 50 percentage mortality, 32 percentage survived with mutilating surgery and 18 percentage of patients survived with no resiual effects. Conclusions - In ROCM, early diagnosis has good clinical outcome, therefore when patients with known risk factors for ROCM present with sinusitis, the treating physician should have very high clinical suspicion. We recommend diagnostic nasal endoscopy with biopsy of nasal tissue for Histo pathological examination and fungal smear and culture from suspected sites along with contrast enhanced CT scan of the PNS, orbit and Brain, that will help in getting an early clinical staging. We found in our study that Intra orbital and intra cranial involvement are associated with high morbidity and mortality rate. Early diagnosis, aggressive surgical debridement with administration of systemic Amphotericin B and control of systemic illness are the key stones for a good outcome.