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Published on: November 7, 2020
Rhino-orbito-cerebral mucormycosis: an epidemic in a pandemic
Anuradha Sekaran1, Nayana Patil1, Swapnali Sabhapandit2
1Department of Pathology, AIG Hospitals, Hyderabad, Telangana, India.
Background:
Opportunistic cases of rhino-orbito-cerebral mucormycosis (ROCM) have increased in India during the coronavirus disease 2019 (COVID-19) pandemic.
Aim:
To study laboratory parameters, histopathological features of sinus mucosal biopsies and exenterated orbit specimens, and clinical aspects of patients with ROCM.
Materials And Methods:
Retrospective analysis of nasal and sinus debridement biopsies and orbital exenteration specimens of 30 patients was undertaken, along with analysis of laboratory parameters, clinical history of predisposing conditions, and medication history during COVID-19.
Results:
All patients were either in recovery following COVID-19 or had ongoing infection. Most patients were diabetic with increased glycosylated haemoglobin, and most patients received steroids and antibiotics for COVID-19. Thirty sinonasal mucosal debridement specimens from various sites, nine orbital exenteration specimens and one frontal decompression craniectomy specimen were examined. Mucor spp. were observed in necrotic tissue, and the presence of vessel and nerve invasion was documented. There were four deaths.
Conclusion:
ROCM is a life-threatening disease. A high index of suspicion with prompt aggressive surgical and medical management by a multi-disciplinary team can be life saving. Efforts to maintain an optimal glycaemic index is likely to be helpful in preventing ROCM. Judicious use of steroids is mandatory to control the collateral epidemic of ROCM in India.
Insights
Rhino-orbito-cerebral mucormycosis (ROCM) cases surged in India during the COVID-19 pandemic, particularly in diabetic patients using steroids. Prompt multidisciplinary management is crucial for survival.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pathology
Background:
- Opportunistic rhino-orbito-cerebral mucormycosis (ROCM) cases have notably increased in India.
- This surge coincided with the coronavirus disease 2019 (COVID-19) pandemic.
Purpose of the Study:
- To investigate laboratory parameters in ROCM patients.
- To analyze histopathological features of sinus mucosal biopsies and orbital specimens.
- To document clinical aspects of ROCM patients during the COVID-19 pandemic.
Main Methods:
- Retrospective analysis of 30 ROCM patients.
- Examination of sinonasal debridement and orbital exenteration specimens.
- Review of laboratory results, clinical history, and medication use during COVID-19.
Main Results:
- Most ROCM patients had diabetes mellitus with elevated glycosylated hemoglobin.
- Many patients received steroids and antibiotics for COVID-19.
- Mucor spp. were identified in necrotic tissue with vessel and nerve invasion; four deaths occurred.
Conclusions:
- ROCM is a life-threatening fungal infection requiring high suspicion and aggressive multidisciplinary management.
- Maintaining optimal glycemic control is vital for preventing ROCM.
- Judicious steroid use is essential to mitigate the collateral epidemic of ROCM.
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