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Rhino-orbital-cerebral mucormycosis in times of COVID-19: A neurosurgical experience
Hershdeep Singh1, Sanjeev Dua1, Amitabh Goel1
1Department of Neurosurgery, Max Hospital, Patparganj, New Delhi, India.
Background:
The gravity of "second wave" of COVID-19 has effaced many new challenges in India; mucormycosis being a recent one. Diabetes mellitus (DM) is a known significant risk factor for mucormycosis. Here, we present our experience with rhino-orbital-cerebral mucormycosis (ROCM) during the "second wave of COVID-19" at a tertiary health care centre in North India.
Methods:
This case series includes four cases of ROCM that were managed by our neurosurgical team in view ofcerebral involvement.
Results:
All the cases with an exception of one (Case 1), had a history of treatment for COVID-19 pneumonia. Case 2, 3 had undergone functional endoscopic sinus surgery (FESS) and orbital decompression before the onset of cerebral involvement; Case 4 underwent FESS and cranial surgery in the same sitting. All the patients had a history of DM and all the cases treated for COVID-19 pneumonia had a history of treatment with corticosteroids. Two patients underwent surgery with the exception of one patient, who did not provide consent for the same. One patient expired before surgical excision could be attempted.
Conclusion:
Regular and intensive follow-up is the key in swift detection and management of ROCM in post-COVID patients. While surgical excision is advisable in the fungal lesion, it must be borne in mind that radical excision of cerebral lesions is associated with morbidity, delayed recovery, and prolonged ICU stay. Culture and sensitivity-based antibiotics should be used judiciously as fever is a common postoperative complication. Blood sugar monitoring and control of DM are paramount in this condition. Steroids should be avoided in the management of cerebral edema with judicious use of hypertonic saline or mannitol.
Insights
Rhino-orbital-cerebral mucormycosis (ROCM) is a serious fungal infection seen in post-COVID-19 patients, especially those with diabetes mellitus. Early detection and management, including surgical intervention and strict blood sugar control, are crucial for better outcomes.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Endocrinology
Background:
- The second wave of COVID-19 in India presented challenges, including a rise in mucormycosis cases.
- Diabetes mellitus (DM) is a significant risk factor for mucormycosis.
- This study focuses on rhino-orbital-cerebral mucormycosis (ROCM) during the COVID-19 second wave in North India.
Purpose of the Study:
- To present the neurosurgical team's experience managing four cases of ROCM with cerebral involvement.
- To highlight the challenges and outcomes of ROCM management in post-COVID-19 patients.
Main Methods:
- A case series of four patients with ROCM and cerebral involvement managed by a neurosurgical team.
- Surgical interventions included functional endoscopic sinus surgery (FESS), orbital decompression, and cranial surgery.
Main Results:
- Three out of four patients had a history of COVID-19 pneumonia and corticosteroid treatment.
- All patients had a history of diabetes mellitus.
- Two patients underwent surgery; one patient expired before surgery could be attempted.
Conclusions:
- Intensive follow-up is essential for early detection and management of ROCM in post-COVID-19 patients.
- Surgical excision of fungal lesions is recommended, but radical excision of cerebral lesions may increase morbidity.
- Strict blood sugar control in diabetic patients is paramount; steroids should be used cautiously, and antibiotics guided by culture and sensitivity.
