Clinical characteristics and analysis of treatment outcome at one year of rhino-orbito-cerebral mucormycosis cases during the second wave of the Covid-19 pandemic (2nd wave); experiences from a tertiary care hospital in Kolkata, India

Abstract

Literature published between December 2019 and March 2021 suggested that India had contributed to approximately 71% of the total global cases of mucormycosis in patients with COVID-19. This study aimed to analyse the clinical patterns and evaluate treatment outcomes at twelve months of rhino-orbital-cerebral mucormycosis (ROCM) diagnosed during the Covid -19 pandemic second wave.A prospective observational study was carried out at the School of Tropical Medicine, Kolkata between April 2021 and May 2021. Intravenous liposomal amphotericin B injection (10 mg/kg/day for 42 days in patients with cerebral involvement and 5mg/kg/day for 21 days in patients with non-cerebral involvement) was initiated followed by oral posaconazole (300 mg twice on the first day, followed by 300 mg daily for 6–12 months) (as per ICMR guidelines). Diabetes and other co-morbidities were adequately optimised.Seventeen patients were admitted with symptoms of ROCM with males outnumbering females. Four patients (23.5%) with extensive cerebral involvement died within the first week of initiation of treatment. Three (17.6%) patients had diabetic ketoacidosis. The survival rate of overall ROCM was 76.5%.The study shows that timely diagnosis and appropriate treatment reduces the mortality of ROCM except in cerebral involvement, where the outcome was guarded despite aggressive treatment. Six-month treatment was inadequate in most of the cases, and multiple surgical interventions along with antifungals accelerated the recovery.