Emerging problem to health care workers in form of virus and fungus combo: a tertiary care centre experience

Abstract

Background: Rhino-orbital-cerebral mucormycosis has reached epidemic proportion during second wave of COVID-19 pandemic in India. In this study we aimed to understand the demographics, presentation, temporal sequence, risk factors and outcomes to undertake measures for prevention and treatment and benefit of administering liposomal amphotericin via retrobulbar injection in addition to systemic antifungals in the setting of rhino-orbital-mucormycosis.Methods: Study of patients with COVID-19-associated mucormycosis managed or co-managed by ophthalmologists in our centre from April 2021 to June 2021.Results: Male predominance and more than 75% associated with COVID-19 infection. Common risk factors associated were DM and corticosteroids use. Unilateral involvement was common (82.4%). Most common primary symptom and sign of ROCM is orbital/facial pain (68.4%) and ptosis (84.2 %) respectively. retro bulbar amphotericin B injections had slight improvement in vision (25%), ptosis (37.5%) and extra ocular movement (25%) with few complications. Surgical management were PNS debridement (42.1%), exenteration added in 17.5 % and with above procedure additional maxillectomy needed in 14%. 22.8 % cases were succumbed by disease while 40.1 % of live patients needed orbital exenteration.Conclusions: ROCM has visible signs and symptoms, help us in early diagnosis as compared to mucormycosis at other anatomical sites and should be known to all ophthalmologists. Early diagnosis by involving root level health worker and creation of standard treatment guideline on emerging heath problem is an urgent need.