A clinical study of rhino-orbital-cerebral mucormycosis during the COVID-19 pandemic in western Maharashtra.

IF 1.1 Q4 PRIMARY HEALTH CARE
Varsha Vivek Manade, Megha R Kotecha
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Abstract

Background: The aim of the study was to describe the epidemiology and study the risk factors, clinical presentation, management, and outcome of rhino-orbital-cerebral mucormycosis (ROCM) in terms of mortality, exenteration, eye salvage, and vision salvage.

Methods: This retrospective, observational study was carried out over a period of two months. A detailed history was noted, and an ophthalmological examination was done. The diagnosis was done by Potassium hydroxide (KOH) mount and fungal culture. Magnetic resonance imaging (MRI) of the orbit, brain, and paranasal sinuses were performed. Medical (intravenous amphotericin B, posaconazole), surgical (retrobulbar amphotericin B injection, exenteration, Functional Endoscopic Sinus Surgery (FESS)), or combined management was evaluated, and clinical outcomes was noted.

Results: The mean age of patients was 54.2 years and the male-to-female ratio was 1.77/1. The most common underlying risk factor for ROCM was uncontrolled diabetes mellitus (70%), followed by the use of corticosteroids for the management of coronavirus disease 2019 (COVID-19) infection in 68% of patients. The most common clinical presentation was diminution of vision followed by eschar, ptosis, and proptosis. Medical and FESS were done in all patients; exenteration was done in 12% of patients. Sixty-six percent of patients were alive with regression of ROCM, 20% of patients were alive with residual, 8% of patients were alive with the progression of ROCM, and 6% of patients had expired. Among the ones who are alive, the ocular outcome was orbital exenteration in 12.76%, the eye was salvaged in 25.53 and vision salvage was achieved in 61.70%.

Conclusion: ROCM affects older males. Immunosuppression due to COVID-19 infection, diabetes mellitus, and corticosteroid use in the management of COVID-19 are the main risk factors for the development of ROCM. Antifungal therapy along with surgical debridement decreases mortality.

马哈拉施特拉邦西部 COVID-19 大流行期间鼻眶脑粘液瘤病的临床研究。
研究背景本研究旨在描述流行病学,并研究鼻眶脑粘液瘤病(ROCM)的风险因素、临床表现、管理以及死亡率、开颅手术、眼球挽救和视力挽救方面的结果:这项回顾性观察研究为期两个月。研究人员详细询问了病史,并进行了眼科检查。通过氢氧化钾(KOH)装片和真菌培养进行诊断。对眼眶、大脑和副鼻窦进行了磁共振成像(MRI)检查。对药物治疗(静脉注射两性霉素 B、泊沙康唑)、手术治疗(球后注射两性霉素 B、外翻、功能性内窥镜鼻窦手术(FESS))或综合治疗进行了评估,并记录了临床结果:患者平均年龄为 54.2 岁,男女比例为 1.77/1。ROCM最常见的潜在危险因素是未控制的糖尿病(70%),其次是使用皮质类固醇治疗冠状病毒病2019(COVID-19)感染的患者(68%)。最常见的临床表现是视力减退,其次是眼底脓肿、眼睑下垂和突眼。所有患者均接受了内科治疗和人工晶体植入术;12%的患者接受了外扩术。66% 的患者因 ROCM 消退而存活,20% 的患者因残留而存活,8% 的患者因 ROCM 进展而存活,6% 的患者死亡。在存活的患者中,12.76%的患者眼部结果为眼眶外翻,25.53%的患者眼球得到挽救,61.70%的患者视力得到挽救:结论:ROCM好发于老年男性。COVID-19感染导致的免疫抑制、糖尿病以及在治疗COVID-19过程中使用皮质类固醇是ROCM发病的主要风险因素。抗真菌治疗和手术清创可降低死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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7.10%
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