AN INSTITUTIONAL STUDY ON COVID-19 ASSOCIATED RHINO-ORBITAL-CEREBRAL MUCORMYCOSIS

Background: Prior to the COVID-19 pandemic, the prevalence of mucormycosis in India was approximately 0.14 cases per 1000 population. With the second wave of the COVID-19 pandemic, there has been a tremendous increase in the number of Rhino-Orbital mucormycosis cases with a high mortality of 30.7%.This paper discusses the institutional experience of 67 cases of rhino–orbital–cerebral mucormycosis related to COVID-19 infection. Methods: In this case series, 67 proven cases of COVID-19 associated rhino-orbital-cerebral mucormycosis were analyzed retrospectively from April 2021 to March 2022. Clinical profile of all the patients were studied for signs and symptoms at presentation, possible risk factors and comorbidities. Microbiological and imaging studies was done in all patients and taken up for surgical management which included open or endoscopic debridement, maxillectomy, orbital decompression, orbital exenteration etc. Postoperatively patients were started on parenteral antifungal and discharged on oral antifungal after repeat imaging and endoscopy to rule out residual or recurrent disease. Results: The mean age of presentation was 49.1 years. Diabetes and use of steroids during covid treatment was seen in 91% and 83.5% of cases respectively. Unilateral headache and nasal obstruction were the most common symptoms. Open debridement using Weber Ferguson incision and medial maxillectomy was the most common surgical approach followed in our institution with good recovery and less chances of need for revision surgery. Conclusion: Timely diagnosis and intervention in the form of thorough surgical debridement and antifungal therapy are critical aspects in improving clinical outcomes in such patients.