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      Surgical & Medical Management of ROCM (Rhino-Orbito-Cerebral Mucormycosis) Epidemic in COVID-19 era and its Outcomes – a Tertiary Care Center Experience

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective

          : To evaluate the outcome of patients with ROCM (Rhino-orbito-cerebral mucormycosis) following their medical and surgical management.

          Materials and methods

          : It is a prognostic study based in a tertiary care center in North-Western India. Patients who developed ROCM post COVID-19 infection from 1 st September, 2020 to 30 th June, 2021 were included in this study. Surgical debridement and administration of antifungal therapy was done for the post-COVID-19 ROCM patients. Disease progression and survival was studied up to 5 months of follow-up in the second wave.

          Results

          : A total of 145 ROCM patients were included. The mean age at presentation, male: female ratio was 48.2 years and 2:1 respectively. As per our proposed new staging system and treatment strategy, the majority of patients belonged to stage II (31.72%) and stage III (31.03%). On a follow-up period of 5 months, 26 (18%) patients have lost their life and rest of the patients are on strict follow-up.

          Conclusion

          : ROCM is an extremely aggressive fungal infection which rapidly became an epidemic following the COVID-19 pandemic. The diverse and unique presentation led us to evolve a new strategy to classify and manage these patients.

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          Most cited references21

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          Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

          Dawei Wang, Bo Hu, Fangfang Zhu … (2020)
          In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
          Article 0 comments Cited 10931 times – based on 0 reviews     Review now
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            Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium

            Oliver Cornely, Ana Alastruey-Izquierdo, Dorothee Arenz … (2019)
            Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
            Article 0 comments Cited 584 times – based on 0 reviews     Review now
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              Epidemiology and outcome of zygomycosis: a review of 929 reported cases.

              M M Roden, T. E. Zaoutis, W L Buchanan … (2005)
              Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease. We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described. The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively). Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.
              Article 0 comments Cited 479 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Mycol Med
                Journal ID (iso-abbrev): J Mycol Med
                Title: Journal De Mycologie Medicale
                Publisher: SFMM. Published by Elsevier Masson SAS.
                ISSN (Print): 1156-5233
                ISSN (Electronic): 1773-0449
                Publication date PMC-release: 25 December 2021
                Publication date (Electronic): 25 December 2021
                Electronic Location Identifier: 101238
                Affiliations
                [1 ]Associate Professor, Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [2 ]Senior Resident, Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [3 ]Assistant Professor, Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [4 ]Professor and Head, Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [5 ]Additional Professor, Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [6 ]Additional Professor, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [7 ]Assistant Professor, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [8 ]Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [9 ]Assistant Professor, Department of Microbiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [10 ]Additional Professor, Department of Microbiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [11 ]Associate Professor, Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [12 ]Professor, Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [13 ]Professor, Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [14 ]Professor, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [15 ]Professor, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                [16 ]Professor, Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
                Author notes
                [* ]Corresponding author. Dr. Amit Goyal, Professor, Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India, Mobile No.: +91 8003996881
                Article
                Publisher Item ID: S1156-5233(21)00129-3 Publisher ID: 101238
                DOI: 10.1016/j.mycmed.2021.101238
                PMC ID: 8709922
                PubMed ID: 34979299
                SO-VID: a9c32117-a595-41cc-a2ec-bbfdbf02f76d
                Copyright © © 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 13 August 2021
                Date revision received : 14 December 2021
                Date accepted : 23 December 2021
                Categories
                Subject: Article

                Keywords: rocm (rhino-orbito-cerebral mucormycosis),covid-19,staging protocol,outcome,treatment,amphotericin
                Data availability:
                Keywords: rocm (rhino-orbito-cerebral mucormycosis), covid-19, staging protocol, outcome, treatment, amphotericin

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