Multidisciplinary Management of COVID-Associated Mucormycosis Syndemic in India

Abstract

The study aimed to determine clinical presentation, contributing factors, medical and surgical management, and outcome of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM). A cross-sectional, single-center study was conducted on patients receiving multidisciplinary treatment for mucormycosis following the second wave of COVID-19 pandemic from April to June 2021 in India. Clinicoepidemiological factors were analyzed, 30-day overall survival and disease-specific survival were determined, and t-test was used to determine the statistical significance. A total of 215 patients were included in the study, the cases were stratified into sino-nasal 95 (44.2%), sino-naso-orbital 32 (14.9%), sino-naso-palatal 55 (25.6%), sino-naso-cerebral 12 (5.6%), sino-naso-orbito-cerebral 16 (7.4%), and sino-naso-orbito-palato-cerebral 5 (2.3%) based on their presentation. A multidisciplinary team treated patients by surgical wound debridement and medical therapy with broad-spectrum antibiotics and amphotericin B. Across all disease stages, cumulative 30-day disease-specific survival is 94% (p < 0.001, intergroup comparison, Breslow (generalized Wilcoxon) CI 95%) and overall 30-day survival is 87.9% (p < 0.001, intergroup comparison, Breslow (generalized Wilcoxon) CI 95%) (censored). Early identification, triaging, and proper multidisciplinary team management with systemic antifungals, surgical debridement, and control of comorbidities lead to desirable outcomes in COVID-associated mucormycosis. The patients with intracranial involvement have a higher chance of mortality compared to the other group.

Schwerpunkt Ophthalmopathologie Orbitainfektion: vom Hordeolum bis zur nekrotisierenden Fasziitis

“…Mucor fungi have the distinctive feature of being able to infiltrate blood vessel walls and induce thrombosing vasculitis. Tissue necrosis results, presenting clinically as a black scab, which in turn promotes further fungal spread [34].…”

“…In an Indian multicentric study of COVID-associated rhino-orbital mucormycosis, Sen et al reported that 87 % of over 2,800 cases had corticosteroid therapy and 78 % had a diagnosis of diabetes mellitus as risk factors [34]. There was orbital involvement in 72 % of cases.…”

“…Orbital mucormycosis presented with periocular swelling/redness (in 33 %), loss of visual acuity (in 21 %), ptosis (in 12 %), and proptosis (in 11 %). Pain was reported as a primary symptom by 23 % of patients [34]. The "walled off" globe results in restricted eye movements.…”

“…Treatment methods range from intravenous or intraorbital amphotericin B injections through to orbital exenteration [34]. Posaconazole and isavuconazole serve as antifungal alternatives [33].…”

“…Similar to necrotizing fasciitis, the necrotic areas or macroscopically affected areas must be carefully ablated surgically. This is achieved by endoscopic procedures performed by ENT/MXF surgeons, or by major procedures such as maxillectomies [34].…”