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Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1
PURPOSE: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India’s second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including como...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374756/ https://www.ncbi.nlm.nih.gov/pubmed/34156034 http://dx.doi.org/10.4103/ijo.IJO_1565_21 |
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author | Sen, Mrittika Honavar, Santosh G Bansal, Rolika Sengupta, Sabyasachi Rao, Raksha Kim, Usha Sharma, Mukesh Sachdev, Mahipal Grover, Ashok K Surve, Abhidnya Budharapu, Abhishek Ramadhin, Abhishek K Tripathi, Abhishek Kumar Gupta, Adit Bhargava, Aditya Sahu, Animesh Khairnar, Anjali Kochar, Anju Madhavani, Ankita Shrivastava, Ankur K Desai, Anuja K Paul, Anujeet Ayyar, Anuradha Bhatnagar, Aparna Singhal, Aparna Nikose, Archana Sunil Bhargava, Arun Tenagi, Arvind L Kamble, Ashish Nariani, Ashiyana Patel, Bhavin Kashyap, Bibbhuti Dhawan, Bodhraj Vohra, Busaraben Mandke, Charuta Thrishulamurthy, Chinmayee Sambare, Chitra Sarkar, Deepayan Mankad, Devashi Shirishbhai Maheshwari, Dhwani Lalwani, Dilip Kanani, Dipti Patel, Diti Manjandavida, Fairooz P Godhani, Frenali Agarwal, Garima Amol Ravulaparthi, Gayatri Shilpa, Gondhi Vijay Deshpande, Gunjan Thakkar, Hansa Shah, Hardik Ojha, Hare Ram Jani, Harsha Gontia, Jyoti Mishrikotkar, Jyotika P Likhari, Kamalpreet Prajapati, Kamini Porwal, Kavita Koka, Kirthi Dharawat, Kulveer Singh Ramamurthy, Lakshmi B Bhattacharyya, Mainak Saini, Manorama Christy, Marem C Das, Mausumi Hada, Maya Panchal, Mehul Pandharpurkar, Modini Ali, Mohammad Osman Porwal, Mukesh Gangashetappa, Nagaraju Mehrotra, Neelima Bijlani, Neha Gajendragadkar, Nidhi Nagarkar, Nitin M Modi, Palak Rewri, Parveen Sao, Piyushi Patil, Prajakta Salunkhe Giri, Pramod Kapadia, Priti Yadav, Priti Bhagat, Purvi Parekh, Ragini Dyaberi, Rajashekhar Chauhan, Rajender Singh Kaur, Rajwinder Duvesh, Ram Kishan Murthy, Ramesh Dandu, Ravi Varma Kathiara, Ravija Beri, Renu Pandit, Rinal Rani, Rita Hepsi Gupta, Roshmi Pherwani, Ruchi Sapkal, Rujuta Mehta, Rupa Tadepalli, Sameeksha Fatima, Samra Karmarkar, Sandeep Patil, Sandeep Suresh Shah, Sanjana Shah, Sankit Shah, Sapan Dubey, Sarika Gandhi, Saurin Kanakpur, Savitha Mohan, Shalini Bhomaj, Sharad Kerkar, Sheela Jariwala, Shivani Sahu, Shivati Tara, Shruthi Maru, Shruti Kochar Jhavar, Shubha Sharma, Shubhda Gupta, Shweta Kumari, Shwetha Das, Sima Menon, Smita Burkule, Snehal Nisar, Sonam Poonam Kaliaperumal, Subashini Rao, Subramanya Pakrasi, Sudipto Rathod, Sujatha Biradar, Sunil G Kumar, Suresh Dutt, Susheen Bansal, Svati Ravani, Swati Amulbhai Lohiya, Sweta Rizvi, Syed Wajahat Ali Gokhale, Tanmay Lahane, Tatyarao P Vukkadala, Tejaswini Grover, Triveni Bhesaniya, Trupti Chawla, Urmil Singh, Usha Une, Vaishali L Nandedkar, Varsha Subramaniam, Venkata Eswaran, Vidya Chaudhary, Vidya Nair Rangarajan, Viji Dehane, Vipin Sahasrabudhe, Vivek M Sowjanya, Yarra Tupkary, Yashaswini Phadke, Yogita |
author_facet | Sen, Mrittika Honavar, Santosh G Bansal, Rolika Sengupta, Sabyasachi Rao, Raksha Kim, Usha Sharma, Mukesh Sachdev, Mahipal Grover, Ashok K Surve, Abhidnya Budharapu, Abhishek Ramadhin, Abhishek K Tripathi, Abhishek Kumar Gupta, Adit Bhargava, Aditya Sahu, Animesh Khairnar, Anjali Kochar, Anju Madhavani, Ankita Shrivastava, Ankur K Desai, Anuja K Paul, Anujeet Ayyar, Anuradha Bhatnagar, Aparna Singhal, Aparna Nikose, Archana Sunil Bhargava, Arun Tenagi, Arvind L Kamble, Ashish Nariani, Ashiyana Patel, Bhavin Kashyap, Bibbhuti Dhawan, Bodhraj Vohra, Busaraben Mandke, Charuta Thrishulamurthy, Chinmayee Sambare, Chitra Sarkar, Deepayan Mankad, Devashi Shirishbhai Maheshwari, Dhwani Lalwani, Dilip Kanani, Dipti Patel, Diti Manjandavida, Fairooz P Godhani, Frenali Agarwal, Garima Amol Ravulaparthi, Gayatri Shilpa, Gondhi Vijay Deshpande, Gunjan Thakkar, Hansa Shah, Hardik Ojha, Hare Ram Jani, Harsha Gontia, Jyoti Mishrikotkar, Jyotika P Likhari, Kamalpreet Prajapati, Kamini Porwal, Kavita Koka, Kirthi Dharawat, Kulveer Singh Ramamurthy, Lakshmi B Bhattacharyya, Mainak Saini, Manorama Christy, Marem C Das, Mausumi Hada, Maya Panchal, Mehul Pandharpurkar, Modini Ali, Mohammad Osman Porwal, Mukesh Gangashetappa, Nagaraju Mehrotra, Neelima Bijlani, Neha Gajendragadkar, Nidhi Nagarkar, Nitin M Modi, Palak Rewri, Parveen Sao, Piyushi Patil, Prajakta Salunkhe Giri, Pramod Kapadia, Priti Yadav, Priti Bhagat, Purvi Parekh, Ragini Dyaberi, Rajashekhar Chauhan, Rajender Singh Kaur, Rajwinder Duvesh, Ram Kishan Murthy, Ramesh Dandu, Ravi Varma Kathiara, Ravija Beri, Renu Pandit, Rinal Rani, Rita Hepsi Gupta, Roshmi Pherwani, Ruchi Sapkal, Rujuta Mehta, Rupa Tadepalli, Sameeksha Fatima, Samra Karmarkar, Sandeep Patil, Sandeep Suresh Shah, Sanjana Shah, Sankit Shah, Sapan Dubey, Sarika Gandhi, Saurin Kanakpur, Savitha Mohan, Shalini Bhomaj, Sharad Kerkar, Sheela Jariwala, Shivani Sahu, Shivati Tara, Shruthi Maru, Shruti Kochar Jhavar, Shubha Sharma, Shubhda Gupta, Shweta Kumari, Shwetha Das, Sima Menon, Smita Burkule, Snehal Nisar, Sonam Poonam Kaliaperumal, Subashini Rao, Subramanya Pakrasi, Sudipto Rathod, Sujatha Biradar, Sunil G Kumar, Suresh Dutt, Susheen Bansal, Svati Ravani, Swati Amulbhai Lohiya, Sweta Rizvi, Syed Wajahat Ali Gokhale, Tanmay Lahane, Tatyarao P Vukkadala, Tejaswini Grover, Triveni Bhesaniya, Trupti Chawla, Urmil Singh, Usha Une, Vaishali L Nandedkar, Varsha Subramaniam, Venkata Eswaran, Vidya Chaudhary, Vidya Nair Rangarajan, Viji Dehane, Vipin Sahasrabudhe, Vivek M Sowjanya, Yarra Tupkary, Yashaswini Phadke, Yogita |
author_sort | Sen, Mrittika |
collection | PubMed |
description | PURPOSE: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India’s second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. METHODS: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. RESULTS: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). CONCLUSION: Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome. |
format | Online Article Text |
id | pubmed-8374756 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-83747562021-08-25 Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1 Sen, Mrittika Honavar, Santosh G Bansal, Rolika Sengupta, Sabyasachi Rao, Raksha Kim, Usha Sharma, Mukesh Sachdev, Mahipal Grover, Ashok K Surve, Abhidnya Budharapu, Abhishek Ramadhin, Abhishek K Tripathi, Abhishek Kumar Gupta, Adit Bhargava, Aditya Sahu, Animesh Khairnar, Anjali Kochar, Anju Madhavani, Ankita Shrivastava, Ankur K Desai, Anuja K Paul, Anujeet Ayyar, Anuradha Bhatnagar, Aparna Singhal, Aparna Nikose, Archana Sunil Bhargava, Arun Tenagi, Arvind L Kamble, Ashish Nariani, Ashiyana Patel, Bhavin Kashyap, Bibbhuti Dhawan, Bodhraj Vohra, Busaraben Mandke, Charuta Thrishulamurthy, Chinmayee Sambare, Chitra Sarkar, Deepayan Mankad, Devashi Shirishbhai Maheshwari, Dhwani Lalwani, Dilip Kanani, Dipti Patel, Diti Manjandavida, Fairooz P Godhani, Frenali Agarwal, Garima Amol Ravulaparthi, Gayatri Shilpa, Gondhi Vijay Deshpande, Gunjan Thakkar, Hansa Shah, Hardik Ojha, Hare Ram Jani, Harsha Gontia, Jyoti Mishrikotkar, Jyotika P Likhari, Kamalpreet Prajapati, Kamini Porwal, Kavita Koka, Kirthi Dharawat, Kulveer Singh Ramamurthy, Lakshmi B Bhattacharyya, Mainak Saini, Manorama Christy, Marem C Das, Mausumi Hada, Maya Panchal, Mehul Pandharpurkar, Modini Ali, Mohammad Osman Porwal, Mukesh Gangashetappa, Nagaraju Mehrotra, Neelima Bijlani, Neha Gajendragadkar, Nidhi Nagarkar, Nitin M Modi, Palak Rewri, Parveen Sao, Piyushi Patil, Prajakta Salunkhe Giri, Pramod Kapadia, Priti Yadav, Priti Bhagat, Purvi Parekh, Ragini Dyaberi, Rajashekhar Chauhan, Rajender Singh Kaur, Rajwinder Duvesh, Ram Kishan Murthy, Ramesh Dandu, Ravi Varma Kathiara, Ravija Beri, Renu Pandit, Rinal Rani, Rita Hepsi Gupta, Roshmi Pherwani, Ruchi Sapkal, Rujuta Mehta, Rupa Tadepalli, Sameeksha Fatima, Samra Karmarkar, Sandeep Patil, Sandeep Suresh Shah, Sanjana Shah, Sankit Shah, Sapan Dubey, Sarika Gandhi, Saurin Kanakpur, Savitha Mohan, Shalini Bhomaj, Sharad Kerkar, Sheela Jariwala, Shivani Sahu, Shivati Tara, Shruthi Maru, Shruti Kochar Jhavar, Shubha Sharma, Shubhda Gupta, Shweta Kumari, Shwetha Das, Sima Menon, Smita Burkule, Snehal Nisar, Sonam Poonam Kaliaperumal, Subashini Rao, Subramanya Pakrasi, Sudipto Rathod, Sujatha Biradar, Sunil G Kumar, Suresh Dutt, Susheen Bansal, Svati Ravani, Swati Amulbhai Lohiya, Sweta Rizvi, Syed Wajahat Ali Gokhale, Tanmay Lahane, Tatyarao P Vukkadala, Tejaswini Grover, Triveni Bhesaniya, Trupti Chawla, Urmil Singh, Usha Une, Vaishali L Nandedkar, Varsha Subramaniam, Venkata Eswaran, Vidya Chaudhary, Vidya Nair Rangarajan, Viji Dehane, Vipin Sahasrabudhe, Vivek M Sowjanya, Yarra Tupkary, Yashaswini Phadke, Yogita Indian J Ophthalmol Expedited Publication, Original Article PURPOSE: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India’s second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. METHODS: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. RESULTS: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). CONCLUSION: Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome. Wolters Kluwer - Medknow 2021-07 2021-06-18 /pmc/articles/PMC8374756/ /pubmed/34156034 http://dx.doi.org/10.4103/ijo.IJO_1565_21 Text en Copyright: © 2021 Indian 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 | Expedited Publication, Original Article Sen, Mrittika Honavar, Santosh G Bansal, Rolika Sengupta, Sabyasachi Rao, Raksha Kim, Usha Sharma, Mukesh Sachdev, Mahipal Grover, Ashok K Surve, Abhidnya Budharapu, Abhishek Ramadhin, Abhishek K Tripathi, Abhishek Kumar Gupta, Adit Bhargava, Aditya Sahu, Animesh Khairnar, Anjali Kochar, Anju Madhavani, Ankita Shrivastava, Ankur K Desai, Anuja K Paul, Anujeet Ayyar, Anuradha Bhatnagar, Aparna Singhal, Aparna Nikose, Archana Sunil Bhargava, Arun Tenagi, Arvind L Kamble, Ashish Nariani, Ashiyana Patel, Bhavin Kashyap, Bibbhuti Dhawan, Bodhraj Vohra, Busaraben Mandke, Charuta Thrishulamurthy, Chinmayee Sambare, Chitra Sarkar, Deepayan Mankad, Devashi Shirishbhai Maheshwari, Dhwani Lalwani, Dilip Kanani, Dipti Patel, Diti Manjandavida, Fairooz P Godhani, Frenali Agarwal, Garima Amol Ravulaparthi, Gayatri Shilpa, Gondhi Vijay Deshpande, Gunjan Thakkar, Hansa Shah, Hardik Ojha, Hare Ram Jani, Harsha Gontia, Jyoti Mishrikotkar, Jyotika P Likhari, Kamalpreet Prajapati, Kamini Porwal, Kavita Koka, Kirthi Dharawat, Kulveer Singh Ramamurthy, Lakshmi B Bhattacharyya, Mainak Saini, Manorama Christy, Marem C Das, Mausumi Hada, Maya Panchal, Mehul Pandharpurkar, Modini Ali, Mohammad Osman Porwal, Mukesh Gangashetappa, Nagaraju Mehrotra, Neelima Bijlani, Neha Gajendragadkar, Nidhi Nagarkar, Nitin M Modi, Palak Rewri, Parveen Sao, Piyushi Patil, Prajakta Salunkhe Giri, Pramod Kapadia, Priti Yadav, Priti Bhagat, Purvi Parekh, Ragini Dyaberi, Rajashekhar Chauhan, Rajender Singh Kaur, Rajwinder Duvesh, Ram Kishan Murthy, Ramesh Dandu, Ravi Varma Kathiara, Ravija Beri, Renu Pandit, Rinal Rani, Rita Hepsi Gupta, Roshmi Pherwani, Ruchi Sapkal, Rujuta Mehta, Rupa Tadepalli, Sameeksha Fatima, Samra Karmarkar, Sandeep Patil, Sandeep Suresh Shah, Sanjana Shah, Sankit Shah, Sapan Dubey, Sarika Gandhi, Saurin Kanakpur, Savitha Mohan, Shalini Bhomaj, Sharad Kerkar, Sheela Jariwala, Shivani Sahu, Shivati Tara, Shruthi Maru, Shruti Kochar Jhavar, Shubha Sharma, Shubhda Gupta, Shweta Kumari, Shwetha Das, Sima Menon, Smita Burkule, Snehal Nisar, Sonam Poonam Kaliaperumal, Subashini Rao, Subramanya Pakrasi, Sudipto Rathod, Sujatha Biradar, Sunil G Kumar, Suresh Dutt, Susheen Bansal, Svati Ravani, Swati Amulbhai Lohiya, Sweta Rizvi, Syed Wajahat Ali Gokhale, Tanmay Lahane, Tatyarao P Vukkadala, Tejaswini Grover, Triveni Bhesaniya, Trupti Chawla, Urmil Singh, Usha Une, Vaishali L Nandedkar, Varsha Subramaniam, Venkata Eswaran, Vidya Chaudhary, Vidya Nair Rangarajan, Viji Dehane, Vipin Sahasrabudhe, Vivek M Sowjanya, Yarra Tupkary, Yashaswini Phadke, Yogita Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1 |
title | Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1 |
title_full | Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1 |
title_fullStr | Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1 |
title_full_unstemmed | Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1 |
title_short | Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1 |
title_sort | epidemiology, clinical profile, management, and outcome of covid-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in india – collaborative opai-ijo study on mucormycosis in covid-19 (cosmic), report 1 |
topic | Expedited Publication, Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374756/ https://www.ncbi.nlm.nih.gov/pubmed/34156034 http://dx.doi.org/10.4103/ijo.IJO_1565_21 |
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