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Clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of COVID-19: A retrospective study

PURPOSE: The purpose was to study the demographics, clinical and radiological presenting patterns, prognostic variables, and outcome of management of rhino-orbital-cerebral-mucormycosis (ROCM) in coronavirus disease (COVID-19) patients. METHODS: We retrospectively analyzed COVID-19 patients with pro...

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Autores principales: Hanumappa, Swetha M., Karuppannasamy, Divya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10365243/
https://www.ncbi.nlm.nih.gov/pubmed/37492213
http://dx.doi.org/10.4103/sjopt.sjopt_155_22
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author Hanumappa, Swetha M.
Karuppannasamy, Divya
author_facet Hanumappa, Swetha M.
Karuppannasamy, Divya
author_sort Hanumappa, Swetha M.
collection PubMed
description PURPOSE: The purpose was to study the demographics, clinical and radiological presenting patterns, prognostic variables, and outcome of management of rhino-orbital-cerebral-mucormycosis (ROCM) in coronavirus disease (COVID-19) patients. METHODS: We retrospectively analyzed COVID-19 patients with proven ROCM from April 2021 to November 2021. All included patients were given systemic antifungal therapy depending on clinical response and underwent functional endoscopic sinus surgery (FESS) with orbital wall decompression. Administration of transcutaneous retrobulbar amphotericin B (TRAMB) injection, exenteration, and maxillectomy was done when indicated as per a novel algorithm. RESULTS: A total of 64 patients with ROCM were included in the study. The mean age of 54.5 (standard deviation [SD] - 10.6) years with a male predominance (male: female = 55:9) was observed. Pre-existing diabetes mellitus (DM) was the most common comorbid state, 47 (73.4%). The most common ophthalmic presentation was proptosis (n = 40) (62.5%). Bulky extraocular muscles (n = 64) (100%) and intraorbital fat stranding (n = 41) (64%) were the most common radiological findings. Twenty-eight patients received TRAMB, while 11 patients underwent exenteration with FESS. Our study had a mortality rate of 18.7% (n = 12). The mean glycated hemoglobin of 13.5% (SD - 1.1) and a higher serum ferritin value of 976.25 (SD - 592) were observed in the deceased group. Vision was preserved in 38 (73.7%) patients in the survived group. CONCLUSION: ROCM has a wide array of presentations, with proptosis as the most common clinical finding. Bulky EOM and intraorbital fat stranding were the most common radiological findings. Thorough surgical debridement with systemic and local antifungal therapy results in reasonable outcomes for ROCM in COVID-19 patients. Older age, intensive care unit admissions, uncontrolled DM, central nervous system involvement, and shorter duration of antifungal treatment are poor prognostic factors associated with mortality.
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spelling pubmed-103652432023-07-25 Clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of COVID-19: A retrospective study Hanumappa, Swetha M. Karuppannasamy, Divya Saudi J Ophthalmol Original Article PURPOSE: The purpose was to study the demographics, clinical and radiological presenting patterns, prognostic variables, and outcome of management of rhino-orbital-cerebral-mucormycosis (ROCM) in coronavirus disease (COVID-19) patients. METHODS: We retrospectively analyzed COVID-19 patients with proven ROCM from April 2021 to November 2021. All included patients were given systemic antifungal therapy depending on clinical response and underwent functional endoscopic sinus surgery (FESS) with orbital wall decompression. Administration of transcutaneous retrobulbar amphotericin B (TRAMB) injection, exenteration, and maxillectomy was done when indicated as per a novel algorithm. RESULTS: A total of 64 patients with ROCM were included in the study. The mean age of 54.5 (standard deviation [SD] - 10.6) years with a male predominance (male: female = 55:9) was observed. Pre-existing diabetes mellitus (DM) was the most common comorbid state, 47 (73.4%). The most common ophthalmic presentation was proptosis (n = 40) (62.5%). Bulky extraocular muscles (n = 64) (100%) and intraorbital fat stranding (n = 41) (64%) were the most common radiological findings. Twenty-eight patients received TRAMB, while 11 patients underwent exenteration with FESS. Our study had a mortality rate of 18.7% (n = 12). The mean glycated hemoglobin of 13.5% (SD - 1.1) and a higher serum ferritin value of 976.25 (SD - 592) were observed in the deceased group. Vision was preserved in 38 (73.7%) patients in the survived group. CONCLUSION: ROCM has a wide array of presentations, with proptosis as the most common clinical finding. Bulky EOM and intraorbital fat stranding were the most common radiological findings. Thorough surgical debridement with systemic and local antifungal therapy results in reasonable outcomes for ROCM in COVID-19 patients. Older age, intensive care unit admissions, uncontrolled DM, central nervous system involvement, and shorter duration of antifungal treatment are poor prognostic factors associated with mortality. Wolters Kluwer - Medknow 2023-05-26 /pmc/articles/PMC10365243/ /pubmed/37492213 http://dx.doi.org/10.4103/sjopt.sjopt_155_22 Text en Copyright: © 2023 Saudi Journal of Ophthalmology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Hanumappa, Swetha M.
Karuppannasamy, Divya
Clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of COVID-19: A retrospective study
title Clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of COVID-19: A retrospective study
title_full Clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of COVID-19: A retrospective study
title_fullStr Clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of COVID-19: A retrospective study
title_full_unstemmed Clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of COVID-19: A retrospective study
title_short Clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of COVID-19: A retrospective study
title_sort clinical profile, prognostic factors, and outcomes of rhino-orbital-cerebral mucormycosis in the setting of covid-19: a retrospective study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10365243/
https://www.ncbi.nlm.nih.gov/pubmed/37492213
http://dx.doi.org/10.4103/sjopt.sjopt_155_22
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