Indian Journal of Ophthalmology (Jan 2021)

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

  • Mrittika Sen,
  • Santosh G Honavar,
  • Sabyasachi Sengupta,
  • Raksha Rao,
  • Usha Kim,
  • Mukesh Sharma,
  • Mahipal Sachdev,
  • Ashok K Grover,
  • Abhidnya Surve,
  • Abhishek Budharapu,
  • Abhishek K Ramadhin,
  • Abhishek Kumar Tripathi,
  • Adit Gupta,
  • Aditya Bhargava,
  • Animesh Sahu,
  • Anjali Khairnar,
  • Anju Kochar,
  • Ankita Madhavani,
  • Ankur K Shrivastava,
  • Anuja K Desai,
  • Anujeet Paul,
  • Anuradha Ayyar,
  • Aparna Bhatnagar,
  • Aparna Singhal,
  • Archana Sunil Nikose,
  • Arun Bhargava,
  • Arvind L Tenagi,
  • Ashish Kamble,
  • Ashiyana Nariani,
  • Bhavin Patel,
  • Bibbhuti Kashyap,
  • Bodhraj Dhawan,
  • Busaraben Vohra,
  • Charuta Mandke,
  • Chinmayee Thrishulamurthy,
  • Chitra Sambare,
  • Deepayan Sarkar,
  • Devanshi Shirishbhai Mankad,
  • Dhwani Maheshwari,
  • Dilip Lalwani,
  • Dipti Kanani,
  • Diti Patel,
  • Fairooz P Manjandavida,
  • Frenali Godhani,
  • Garima Amol Agarwal,
  • Gayatri Ravulaparthi,
  • Gondhi Vijay Shilpa,
  • Gunjan Deshpande,
  • Hansa Thakkar,
  • Hardik Shah,
  • Hare Ram Ojha,
  • Harsha Jani,
  • Jyoti Gontia,
  • Jyotika P Mishrikotkar,
  • Kamalpreet Likhari,
  • Kamini Prajapati,
  • Kavita Porwal,
  • Kirthi Koka,
  • Kulveer Singh Dharawat,
  • Lakshmi B Ramamurthy,
  • Mainak Bhattacharyya,
  • Manorama Saini,
  • Marem C Christy,
  • Mausumi Das,
  • Maya Hada,
  • Mehul Panchal,
  • Modini Pandharpurkar,
  • Mohammad Osman Ali,
  • Mukesh Porwal,
  • Nagaraju Gangashetappa,
  • Neelima Mehrotra,
  • Neha Bijlani,
  • Nidhi Gajendragadkar,
  • Nitin M Nagarkar,
  • Palak Modi,
  • Parveen Rewri,
  • Piyushi Sao,
  • Prajakta Salunkhe Patil,
  • Pramod Giri,
  • Priti Kapadia,
  • Priti Yadav,
  • Purvi Bhagat,
  • Ragini Parekh,
  • Rajashekhar Dyaberi,
  • Rajender Singh Chauhan,
  • Rajwinder Kaur,
  • Ram Kishan Duvesh,
  • Ramesh Murthy,
  • Ravi Varma Dandu,
  • Ravija Kathiara,
  • Renu Beri,
  • Rinal Pandit,
  • Rita Hepsi Rani,
  • Roshmi Gupta,
  • Ruchi Pherwani,
  • Rujuta Sapkal,
  • Rupa Mehta,
  • Sameeksha Tadepalli,
  • Samra Fatima,
  • Sandeep Karmarkar,
  • Sandeep Suresh Patil,
  • Sanjana Shah,
  • Sankit Shah,
  • Sapan Shah,
  • Sarika Dubey,
  • Saurin Gandhi,
  • Savitha Kanakpur,
  • Shalini Mohan,
  • Sharad Bhomaj,
  • Sheela Kerkar,
  • Shivani Jariwala,
  • Shivati Sahu,
  • Shruthi Tara,
  • Shruti Kochar Maru,
  • Shubhda Sharma,
  • Shweta Gupta,
  • Shwetha Kumari,
  • Sima Das,
  • Smita Menon,
  • Snehal Burkule,
  • Sonam Poonam Nisar,
  • Subashini Kaliaperumal,
  • Subramanya Rao,
  • Sudipto Pakrasi,
  • Sujatha Rathod,
  • Sunil G Biradar,
  • Suresh Kumar,
  • Susheen Dutt,
  • Svati Bansal,
  • Swati Amulbhai Ravani,
  • Sweta Lohiya,
  • Syed Wajahat Ali Rizvi,
  • Tanmay Gokhale,
  • Tatyarao P Lahane,
  • Tejaswini Vukkadala,
  • Triveni Grover,
  • Trupti Bhesaniya,
  • Urmil Chawla,
  • Usha Singh,
  • Vaishali L Une,
  • Varsha Nandedkar,
  • Venkata Subramaniam,
  • Vidya Eswaran,
  • Vidya Nair Chaudhry,
  • Viji Rangarajan,
  • Vipin Dehane,
  • Vivek M Sahasrabudhe,
  • Yarra Sowjanya,
  • Yashaswini Tupkary,
  • Yogita Phadke

DOI
https://doi.org/10.4103/ijo.IJO_1565_21
Journal volume & issue
Vol. 69, no. 7
pp. 1670 – 1692

Abstract

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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.

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