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Diabetes and rhino-orbito-cerebral mucormycosis - A deadly duo
Parminder Singh1, Saurabh Arora1, Naveen Mittal1
1Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, Punjab 141001 India.
Background:
Rhino-orbito-cerebral mucormycosis(ROCM) is an uncommon yet potentially fatal fungal infection predominantly seen in immunocompromised individuals. However, there is very limited data available from India regarding outcome of patients with ROCM and diabetes mellitus.
Objective:
To ascertain clinical parameters and factors in the final outcome of patients with diabetes mellitus and ROCM.
Materials And Methods:
This series included retrospective analysis of medical records of 91 patients with diabetes mellitus who were diagnosed with ROCM from january 2007 to june 2019 at a tertiary care hospital in Punjab.
Results:
The mean age of patients was 52.6 years (range 18-82 years), with men constituting the majority (71.4 %). Ophthalmoplegia was the most frequent presenting feature seen in 77 % of patients followed by proptosis (71 %). Intracranial involvement was seen in 20 % of the patients and cavernous sinus thrombosis was diagnosed in 9(10 %) patients. Out of 91 patients, 81 patients were subjected to appropriate surgical procedure depending upon site and extent of involvement by mucorales. A total of 53 (58.2 %) patients survived while 38(41.8 %) patients succumbed. Delay in presentation to hospital, intracranial extension and loss of vision at presentation adversely affected the outcome (p < 0.05). Aggressive surgical management in the form of multiple debridements was superior to single debridement (p < 0.05). Diabetic ketoacidosis did not significantly affect the outcome (p = 0.359).
Conclusions:
ROCM in patients with diabetes mellitus, is a rapidly progressive disease with a high fatality rate and grave outcome unless diagnosed early and managed aggressively.
Insights
Rhino-orbito-cerebral mucormycosis (ROCM) in diabetic patients is aggressive and deadly. Early diagnosis and aggressive surgery significantly improve survival rates for this severe fungal infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Endocrinology
Background:
- Rhino-orbito-cerebral mucormycosis (ROCM) is a rare but life-threatening fungal infection.
- It predominantly affects immunocompromised individuals, particularly those with diabetes mellitus.
- Limited data exists on ROCM outcomes in Indian diabetic patients.
Purpose of the Study:
- To investigate clinical features and outcomes of ROCM in patients with diabetes mellitus.
- To identify factors influencing the final outcome of ROCM in this population.
Main Methods:
- Retrospective analysis of medical records of 91 diabetic patients diagnosed with ROCM.
- Study conducted at a tertiary care hospital in Punjab from January 2007 to June 2019.
Main Results:
- The majority of patients were male, with a mean age of 52.6 years.
- Ophthalmoplegia (77%) and proptosis (71%) were the most common symptoms.
- Intracranial involvement occurred in 20% of patients; 58.2% survived, while 41.8% died.
- Delayed presentation, intracranial extension, and vision loss at presentation were associated with poor outcomes.
- Aggressive surgical management, including multiple debridements, improved survival compared to single debridement.
Conclusions:
- ROCM in diabetic patients progresses rapidly and has a high mortality rate.
- Early diagnosis and aggressive management, including surgical intervention, are crucial for improving patient outcomes.
- Diabetic ketoacidosis did not significantly impact the outcome.
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