Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 – A Preliminary Report from a Single Hospital
Ritu Arora,1 Ruchi Goel,1 Samreen Khanam,1 Sumit Kumar,1 Shalin Shah,1 Sonam Singh,1 Mohit Chhabra,1 Ravi Meher,2 Nita Khurana,3 Tanu Sagar,4 Suresh Kumar,5 Sandeep Garg,5 Jyoti Kumar,6 Sonal Saxena,4 Rashmi Pant7 1Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New...
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Dove Medical Press
2021
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oai:doaj.org-article:6cb6bc1a10274a7f988011740e72d85f2021-12-02T16:45:32ZRhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 – A Preliminary Report from a Single Hospital1177-5483https://doaj.org/article/6cb6bc1a10274a7f988011740e72d85f2021-08-01T00:00:00Zhttps://www.dovepress.com/rhino-orbito-cerebral-mucormycosis-during-the-covid-19-second-wave-in--peer-reviewed-fulltext-article-OPTHhttps://doaj.org/toc/1177-5483Ritu Arora,1 Ruchi Goel,1 Samreen Khanam,1 Sumit Kumar,1 Shalin Shah,1 Sonam Singh,1 Mohit Chhabra,1 Ravi Meher,2 Nita Khurana,3 Tanu Sagar,4 Suresh Kumar,5 Sandeep Garg,5 Jyoti Kumar,6 Sonal Saxena,4 Rashmi Pant7 1Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India; 2Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India; 3Department of Pathology, Maulana Azad Medical College, New Delhi, India; 4Department of Microbiology, Maulana Azad Medical College, New Delhi, India; 5Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India; 6Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India; 7Society for Health Education and Allied Research, New Delhi, IndiaCorrespondence: Ruchi GoelDepartment of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, IndiaTel +91 9811305645; +91-11-41440108Email gruchi1@rediffmail.comPurpose: To list the clinico-epidemiological profile and possible risk factors of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) patients presenting to a COVID dedicated hospital during the second wave of COVID-19 in India.Patients and Methods: A cross-sectional, single-center study was done on 60 cases of probable CA-ROCM based on clinical features and supportive diagnostic nasal endoscopic findings and/or radiologic findings. Patients with recent or active COVID-19 were included. The demographic profile, clinical features, possible risk factors and diagnostic workup (microbiological, pathological and radiological) were analysed to identify the triggering factors for CA-ROCM.Results: The age of patients ranged from 29 to 75 years and male–female ratio was 3:1. The duration between the first positive COVID report and onset of CA-ROCM was 0 to 47 days. Forty-nine (81.66%) patients had a recent COVID infection and 11 (18.33%) had active COVID infection at presentation. Thirty-five patients (58%) had ocular/orbital involvement at presentation. In the affected eye, 10 had no perception of light and in the rest visual acuity ranged from log MAR 0 to +1.5. Ocular manifestations were ptosis (29), ophthalmoplegia (23), periocular tenderness and edema (33), proptosis (14), black discoloration of eyelids (3), facial palsy (3), endophthalmitis (4), retinal artery occlusion (8), disc edema (4) and disc pallor (5). Twenty-two (25%) patients had neither received steroids nor oxygen. Thirty patients (50%) were managed with oxygen while 38 patients (63.3%) with systemic steroids. The most common risk factor was diabetes in 59 patients. The average glycosylated hemoglobin (HbA1c) was 10.31 ± 2.59%. Systemic Amphotericin B was started in all the patients. Radical surgical debridement was performed in 12 patients and the remaining were planned.Conclusion: SARS-CoV-2 variant with accompanying glycaemic dysregulation was found to be the triggering factor for the epidemic of CA-ROCM.Keywords: COVID-19 treatment, CA-ROCM, orbital apex syndrome, ophthalmoplegia, retinal arterial occlusion, COVID-19 associated rhino-orbital-cerebral mucormycosisArora RGoel RKhanam SKumar SShah SSingh SChhabra MMeher RKhurana NSagar TKumar SGarg SKumar JSaxena SPant RDove Medical Pressarticlecovid-19 treatmentca-rocmorbital apex syndromeophthalmoplegiaretinal arterial occlusionOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 3505-3514 (2021) |
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EN |
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covid-19 treatment ca-rocm orbital apex syndrome ophthalmoplegia retinal arterial occlusion Ophthalmology RE1-994 |
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covid-19 treatment ca-rocm orbital apex syndrome ophthalmoplegia retinal arterial occlusion Ophthalmology RE1-994 Arora R Goel R Khanam S Kumar S Shah S Singh S Chhabra M Meher R Khurana N Sagar T Kumar S Garg S Kumar J Saxena S Pant R Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 – A Preliminary Report from a Single Hospital |
| description |
Ritu Arora,1 Ruchi Goel,1 Samreen Khanam,1 Sumit Kumar,1 Shalin Shah,1 Sonam Singh,1 Mohit Chhabra,1 Ravi Meher,2 Nita Khurana,3 Tanu Sagar,4 Suresh Kumar,5 Sandeep Garg,5 Jyoti Kumar,6 Sonal Saxena,4 Rashmi Pant7 1Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India; 2Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India; 3Department of Pathology, Maulana Azad Medical College, New Delhi, India; 4Department of Microbiology, Maulana Azad Medical College, New Delhi, India; 5Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India; 6Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India; 7Society for Health Education and Allied Research, New Delhi, IndiaCorrespondence: Ruchi GoelDepartment of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, IndiaTel +91 9811305645; +91-11-41440108Email gruchi1@rediffmail.comPurpose: To list the clinico-epidemiological profile and possible risk factors of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) patients presenting to a COVID dedicated hospital during the second wave of COVID-19 in India.Patients and Methods: A cross-sectional, single-center study was done on 60 cases of probable CA-ROCM based on clinical features and supportive diagnostic nasal endoscopic findings and/or radiologic findings. Patients with recent or active COVID-19 were included. The demographic profile, clinical features, possible risk factors and diagnostic workup (microbiological, pathological and radiological) were analysed to identify the triggering factors for CA-ROCM.Results: The age of patients ranged from 29 to 75 years and male–female ratio was 3:1. The duration between the first positive COVID report and onset of CA-ROCM was 0 to 47 days. Forty-nine (81.66%) patients had a recent COVID infection and 11 (18.33%) had active COVID infection at presentation. Thirty-five patients (58%) had ocular/orbital involvement at presentation. In the affected eye, 10 had no perception of light and in the rest visual acuity ranged from log MAR 0 to +1.5. Ocular manifestations were ptosis (29), ophthalmoplegia (23), periocular tenderness and edema (33), proptosis (14), black discoloration of eyelids (3), facial palsy (3), endophthalmitis (4), retinal artery occlusion (8), disc edema (4) and disc pallor (5). Twenty-two (25%) patients had neither received steroids nor oxygen. Thirty patients (50%) were managed with oxygen while 38 patients (63.3%) with systemic steroids. The most common risk factor was diabetes in 59 patients. The average glycosylated hemoglobin (HbA1c) was 10.31 ± 2.59%. Systemic Amphotericin B was started in all the patients. Radical surgical debridement was performed in 12 patients and the remaining were planned.Conclusion: SARS-CoV-2 variant with accompanying glycaemic dysregulation was found to be the triggering factor for the epidemic of CA-ROCM.Keywords: COVID-19 treatment, CA-ROCM, orbital apex syndrome, ophthalmoplegia, retinal arterial occlusion, COVID-19 associated rhino-orbital-cerebral mucormycosis |
| format |
article |
| author |
Arora R Goel R Khanam S Kumar S Shah S Singh S Chhabra M Meher R Khurana N Sagar T Kumar S Garg S Kumar J Saxena S Pant R |
| author_facet |
Arora R Goel R Khanam S Kumar S Shah S Singh S Chhabra M Meher R Khurana N Sagar T Kumar S Garg S Kumar J Saxena S Pant R |
| author_sort |
Arora R |
| title |
Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 – A Preliminary Report from a Single Hospital |
| title_short |
Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 – A Preliminary Report from a Single Hospital |
| title_full |
Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 – A Preliminary Report from a Single Hospital |
| title_fullStr |
Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 – A Preliminary Report from a Single Hospital |
| title_full_unstemmed |
Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 – A Preliminary Report from a Single Hospital |
| title_sort |
rhino-orbito-cerebral-mucormycosis during the covid-19 second wave in 2021 – a preliminary report from a single hospital |
| publisher |
Dove Medical Press |
| publishDate |
2021 |
| url |
https://doaj.org/article/6cb6bc1a10274a7f988011740e72d85f |
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