Surgical & medical management of ROCM (Rhino-orbito-cerebral mucormycosis) epidemic in COVID-19 era and its outcomes - a tertiary care center experience

J Mycol Med. 2022 May;32(2):101238. doi: 10.1016/j.mycmed.2021.101238. Epub 2021 Dec 25.

Abstract

Objective: To evaluate the outcome of patients with ROCM (Rhino-orbito-cerebral mucormycosis) following their medical and surgical management.

Materials and methods: It is a prognostic study based in a tertiary care center in North-Western India. Patients who developed ROCM post COVID-19 infection from 1st September 2020 to 30th June 2021 were included in this study. Surgical debridement and administration of antifungal therapy was done for the post-COVID-19 ROCM patients. Disease progression and survival was studied up to 5 months of follow-up in the second wave.

Results: A total of 145 ROCM patients were included. The mean age at presentation, male: female ratio was 48.2 years and 2:1 respectively. As per our proposed new staging system and treatment strategy, the majority of patients belonged to stage II (31.72%) and stage III (31.03%). On a follow-up period of 5 months, 26 (18%) patients have lost their life and rest of the patients are on strict follow-up.

Conclusion: ROCM is an extremely aggressive fungal infection which rapidly became an epidemic following the COVID-19 pandemic. The diverse and unique presentation led us to evolve a new strategy to classify and manage these patients.

Keywords: Amphotericin; COVID-19; Outcome; ROCM (rhino-orbito-cerebral mucormycosis); Staging protocol; Treatment.

MeSH terms

  • Antifungal Agents / therapeutic use
  • COVID-19* / epidemiology
  • Eye Infections, Fungal* / drug therapy
  • Female
  • Humans
  • Male
  • Mucormycosis* / drug therapy
  • Mucormycosis* / epidemiology
  • Mucormycosis* / surgery
  • Orbital Diseases* / drug therapy
  • Pandemics
  • SARS-CoV-2
  • Tertiary Care Centers

Substances

  • Antifungal Agents