RHINO-ORBITO-CEREBRAL MUCORMYCOSIS (ROCM), GRAY AREAS OF MANAGEMENT - A STUDY PRESENTING HIGH INCIDENCE WITH COVID-19
DOI:
https://doi.org/10.55519/JAMC-S4-13630Keywords:
Gray areas, Mucormycosis, Mucorales, Rhizopus arrhizus, RCOMAbstract
Background: Rhino-Orbito-Cerebral Mucormycosis is caused by fungi belonging to the Mucorales family, with Rhizopus arrhizus being the most common causative agent. It is a fatal and debilitating condition that is prevalent in developing countries, with a mortality rate ranging from 50% to 85%, reaching 100% in disseminated or untreated cases. The diagnosis is based on tissue histopathology and culture confirmation. Some studies have assessed the efficacy of antifungal regimens. Limited knowledge of the disease, its diverse presentations, delays in early diagnosis, and insufficient efforts to identify the root cause pathogen are key challenges highlighted in the review. Methods: A retrospective study was conducted at Sheikh Zayed Hospital in Lahore, enrolling patients with ROCM from June 2018 to August 2022. Data from patients admitted over five years was collected and analyzed. All patients underwent surgical debridement and received intravenous Amphotericin. A definitive diagnosis was made through microscopic examination of necrotic tissue and cultures. Results: Diabetes mellitus was a common factor among all patients, with a few cases also involving end-stage renal disease and iatrogenic immunosuppression in post-transplant and chemotherapy patients. The study reported a high incidence of ROCM among COVID-19 patients with diabetes mellitus, emphasizing challenges related to treatment costs and patient compliance. Additionally, the one-year survival rate of patients was evaluated. Conclusion: The study concluded that the primary causes of morbidity and mortality included the diversity of disease presentations, missed or delayed diagnoses, inadequate laboratory facilities, high treatment costs, unavailability of antifungal medications, drug toxicity, prolonged hospital stays, and poor follow-up. These issues, along with the emergence of new Mucorales species and drug resistance, underscore the need for focused interventions to address these gray areas.
References
1. Chakrabarti A, Singh R. Mucormycosis in India: Unique features. Mycoses 2014;57(Suppl 3):85–90.
2. Prakash H, Chakrabarti A. Epidemiology of mucormycosis in India. Microorganisms 2021;9(3):523.
3. Pasero D, Sanna S, Liperi C, Piredda D, Branca G Pietro, Casadio L, et al. A challenging complication following SARS-CoV-2 infection: a case of pulmonary mucormycosis. Infection 2021;49(5):1055–60.
4. Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, et al. 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. Lancet Infect Dis 2019;19(12):e405–21.
5. Skiada A, Lass-Floerl C, Klimko N, Ibrahim A, Roilides E, Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol 2018;56:S93–101.
6. Nagalli S, Kikkeri NS. Mucormycosis in COVID-19: A systematic review of the literature. Infez Med 2021;29(4):504–12.
7. Patel A, Agarwal R, Rudramurthy SM, Shevkani M, Xess I, Sharma R, et al. A study presenting high incidence of Rhino-orbito-cerebral mucormycosis with COVID-19 and its management challenges. J Fungi (Basel) 2021;7(9):799.
8. Samendra Karkhur, Soni D, Chauhan K, Sarkar D, Gautam M, Verma S, et al. Rhino-orbito-cerebral mucormycosis and its resurgence during COVID-19 pandemic: A review. Indian Journal of Ophthalmology [Internet]. 2022 Dec 30 [cited 2025 Jan 6];71(1):39–56. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10155578/.
9. Singh AK, Singh R, Joshi SR, Misra A, Muthukumar T. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr 2021;15(4):102146.
10. Spellberg B, Edwards Jr JE, Ibrahim AS. Applying the 2011 Fungal Disease Summit consensus recommendations for the treatment of invasive candidiasis to the Asia-Pacific region. J Antimicrob Chemother 2012;67(4):819–23.
11. Muthu V, Rudramurthy SM, Chakrabarti A, Agarwal R. Epidemiology and pathophysiology of COVID-19-associated mucormycosis: India versus the rest of the world. Mycopathologia 2021;64(11):1196–212.
12. Chakrabarti A, Chatterjee SS, Das A, Panda N. Mucormycosis: a rare but ravaging fungal infection in diabetics. Indian J Med Res 2014;139(5):744–55.
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