Rhino-orbito-cerebral Mucormycosis: Etiopathology, Clinical Features, Outcome, and the Factors Associated with Outcome.

Q3 Medicine
Korean Journal of Ophthalmology : KJO Pub Date : 2022-08-01 Epub Date: 2022-06-15 DOI:10.3341/kjo.2022.0037
Amit Kumar Deb, Rakesh Singh, Subashini Kaliaperumal, Arun Alexander, Tanmay Gokhale, Sandip Sarkar
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引用次数: 1

Abstract

Purpose: Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology, clinical features, treatment outcome, and the factors associated with outcome in ROCM.

Methods: Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings, treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures were evaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identify factors associated with treatment outcome.

Results: On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea, diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relative afferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconal invasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatment outcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation (aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferent pupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two or more sinus involvement (aOR, 4.90; p = 0.009).

Conclusions: The current study identified newer factors in the form of presenting ocular and radiological features as predictors for aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiate these associations.

Abstract Image

Abstract Image

鼻-眶-脑毛霉菌病:病因、临床特征、结果和与结果相关的因素。
目的:毛霉病是一种多系统、侵袭性和机会性真菌感染。最常见的类型是鼻-眶-脑毛霉菌病(ROCM),约占病例的40%。在本研究中,我们分析了ROCM的病因、临床特征、治疗结果以及与结果相关的因素。方法:对52例ROCM患者的病例资料进行分析。从每个病例记录中检索临床参数、实验室参数、影像学表现、治疗方案和治疗结果细节。结果评价为治疗成功和治疗失败。进行单变量和逻辑回归分析以确定与治疗结果相关的因素。结果:在单因素分析中,与治疗效果不良相关的因素有血糖、血尿素不受控制、糖尿病酮症酸中毒、眼部症状持续时间、就诊时无光感、上睑下垂、结膜化脓、相对传入瞳孔缺损、两个或两个以上鼻窦受累、眶壁骨侵蚀、颅内扩张、囊内侵犯等。在随后的logistic回归分析中,与不良治疗结果保持显著相关的因素是血糖不受控制(校正优势比[aOR], 1.17;p = 0.018),呈现时无光感(aOR, 10.67;p = 0.006),首发时上睑下垂(aOR, 3.90;p = 0.03),结膜化脓(aOR, 7.11;p = 0.024),相对传入瞳孔缺损(aOR, 10.60, p = 0.01),首发时视网膜中央动脉闭塞(aOR, 3.54;p = 0.021)和两个或两个以上鼻窦受累(aOR, 4.90;P = 0.009)。结论:目前的研究确定了以眼部和放射学特征的形式出现的新因素作为侵袭性全身性疾病和不良治疗结果的预测因素。然而,未来的前瞻性研究需要证实这些关联。
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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来源期刊
Korean Journal of Ophthalmology : KJO
Korean Journal of Ophthalmology : KJO Medicine-Ophthalmology
CiteScore
2.40
自引率
0.00%
发文量
84
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