Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1

被引：281

作者：

Sen, Mrittika ^{[1
]}

Honavar, Santosh G. ^{[1
]}

Bansal, Rolika ^{[1
]}

Sengupta, Sabyasachi ^{[2
]}

Rao, Raksha ^{[3
]}

Kim, Usha ^{[4
]}

Sharma, Mukesh ^{[5
]}

Sachdev, Mahipal ^{[6
]}

Grover, Ashok K. ^{[7
]}

Surve, Abhidnya ^{[8
]}

Budharapu, Abhishek ^{[9
]}

Ramadhin, Abhishek K. ^{[10
]}

Tripathi, Abhishek Kumar ^{[11
]}

Gupta, Adit ^{[12
]}

Bhargava, Aditya ^{[13
]}

Sahu, Animesh ^{[14
]}

Khairnar, Anjali ^{[15
]}

Kochar, Anju ^{[16
]}

Madhavani, Ankita ^{[17
]}

Shrivastava, Ankur K. ^{[18
]}

Desai, Anuja K. ^{[19
]}

Paul, Anujeet ^{[20
]}

Ayyar, Anuradha ^{[21
]}

Bhatnagar, Aparna ^{[22
]}

Singhal, Aparna ^{[23
]}

Nikose, Archana Sunil ^{[24
]}

Bhargava, Arun ^{[14
]}

Tenagi, Arvind L. ^{[25
]}

Kamble, Ashish ^{[26
]}

Nariani, Ashiyana ^{[27
]}

Patel, Bhavin ^{[28
]}

Kashyap, Bibbhuti ^{[29
]}

Dhawan, Bodhraj ^{[30
]}

Vohra, Busaraben ^{[31
]}

Mandke, Charuta ^{[32
]}

Thrishulamurthy, Chinmayee ^{[33
]}

Sambare, Chitra ^{[34
]}

Sarkar, Deepayan ^{[35
]}

Mankad, Devanshi Shirishbhai ^{[17
]}

Maheshwari, Dhwani ^{[36
]}

Lalwani, Dilip ^{[37
]}

Kanani, Dipti ^{[17
]}

Patel, Diti ^{[31
]}

Manjandavida, Fairooz P. ^{[38
]}

Godhani, Frenali ^{[39
]}

Agarwal, Garima Amol ^{[40
]}

Ravulaparthi, Gayatri ^{[41
]}

Shilpa, Gondhi Vijay ^{[42
]}

Deshpande, Gunjan ^{[43
]}

Thakkar, Hansa ^{[40
]}

机构：

[1] Ctr Sight, Hyderabad, Telangana, India

[2] Future Vis Eye Care & Res Ctr, Mumbai, Maharashtra, India

[3] Narayana Netralaya, Bengaluru, Karnataka, India

[4] Aravind Eye Hosp, Madurai, Tamil Nadu, India

[5] Ctr Sight, Jaipur, Rajasthan, India

[6] Ctr Sight, New Delhi, India

[7] Sir Ganga Ram Hosp & Vis Eye Ctr, Dept Ophthalmol, New Delhi, India

[8] Dr Hedgewar Rugnalaya, Dept Ophthalmol, Aurangabad, Maharashtra, India

[9] Apollo Canc Hosp, Dept Head & Neck Surg, Hyderabad, Telangana, India

[10] Dr Abhishek K Ramadhin Hosp & Avyaan Res Ctr, Dept Otorhinolaryngol, Ranchi, Jharkhand, India

[11] Bharati Vidyapeeth Hosp, Dept Ophthalmol, Sangli, Maharashtra, India

[12] Mumbai Eye Plast Surg, Mumbai, Maharashtra, India

[13] Post Grad Inst Med Sci, Dept Otorhinolaryngol, Rohtak, Haryana, India

[14] Retina Special Hosp, Indore, Madhya Pradesh, India

[15] Shree Bhausaheb Hire Govt Med Coll, Dept Ophthalmol, Dhule, Maharashtra, India

[16] Sardar Patel Med Coll, Dept Ophthalmol, Bikaner, Rajasthan, India

[17] Pandit Deendayal Upadhyay Med Coll, Dept Ophthalmol, Rajkot, Gujarat, India

[18] All India Inst Med Sci, Dept Ophthalmol, Raipur, Chhattisgarh, India

[19] Kusum Dhirajlal Hosp, Dept Ophthalmol, Ahmadabad, Gujarat, India

[20] Mahatma Gandhi Med Coll & Res Inst, Dept Ophthalmol, Pondicherry, India

[21] Oases Eye Care Ctr, Thana, Maharashtra, India

[22] Apollo Specialty Hosp, Dept Ophthalmol, Chennai, Tamil Nadu, India

[23] Maharaja Agrasen Med Coll, Dept Ophthalmol, Agroha, Haryana, India

[24] NKP Salve Inst Med Sci & Res Ctr, Dept Ophthalmol, Nagpur, Maharashtra, India

[25] Karnataka Lingayat Educ Acad Higher Educ & Res, Jawaharlal Nehru Med Coll, Dept Ophthalmol, Belagavi, Karnataka, India

[26] Kingsway Hosp, Dept Ophthalmol, Nagpur, Maharashtra, India

[27] King Edward Mem Hosp & Seth Gordhandas Sunderdas, Dept Ophthalmol, Mumbai, Maharashtra, India

[28] Kiran Super Multispecial Hosp, Dept Otorhinolaryngol, Surat, Gujarat, India

[29] Kashyap Mem Eye Hosp, Ranchi, Jharkhand, India

[30] Alexis Hosp, Dept Ophthalmol, Nagpur, Maharashtra, India

[31] Med Coll Baroda & Sir Sayajirao Gen Hosp, Dept Ophthalmol, Vadodara, Gujarat, India

[32] Hinduhridaysamrat Balasaheb Thackeray Med Coll &, Dept Ophthalmol, Mumbai, Maharashtra, India

[33] Bangalore Med Coll & Res Inst, Dept Ophthalmol, Bengaluru, Karnataka, India

[34] Jehangir Hosp, Dept Ophthalmol, Pune, Maharashtra, India

[35] All India Inst Med Sci, Dept Ophthalmol, Bhopal, Madhya Pradesh, India

[36] Sir Sayajirao Gaekwad Hosp, Dept Ophthalmol, Vadodra, Gujarat, India

[37] Bhaskar Eye Care, Raipur, Chhattisgarh, India

[38] Horus Specialty Eye Care, Bengaluru, Karnataka, India

[39] Jagjivan Ram Railway Hosp, Dept Ophthalmol, Mumbai, Maharashtra, India

[40] Byramjee Jeejeebhoy Med Coll, M&J Western Reg Inst Ophthalmol, Ahmadabad, Gujarat, India

[41] Mamata Acad Med Sci, Dept Ophthalmol, Hyderabad, Telangana, India

[42] Sarojini Devi Eye Hosp, Hyderabad, Telangana, India

[43] Max Vis Eye Hosp, Nagpur, Maharashtra, India

[44] Kusum Dhirajlal Hosp, Dept Otorhinolaryngol, Ahmadabad, Gujarat, India

[45] Raj Eye Hosp, Gorakhpur, Uttar Pradesh, India

[46] Pramukh Swami Med Coll, Dept Ophthalmol, Karamsad, Gujarat, India

[47] Maharaja Yeshwantrao Hosp, Mahatma Gandhi Mem Med Coll, Dept Ophthalmol, Indore, Madhya Pradesh, India

[48] Mahatma Gandhi Mission Med Coll & Hosp, Dept Ophthalmol, Aurangabad, Maharashtra, India

[49] Ratan Jyoti Netralaya, Gwalior, Madhya Pradesh, India

[50] Convenient Hosp Ltd CHL Hosp, Dept Ophthalmol, Indore, Madhya Pradesh, India

来源：

INDIAN JOURNAL OF OPHTHALMOLOGY | 2021年 / 69卷 / 07期

关键词：

Corticosteroids; COVID-19; COVID-19-associated ROCM; diabetes mellitus; mucormycosis; orbital exenteration; paransal sinus debridement; rhino-orbital-cerebral mucormycosis; staging of rhino-orbital-cerebral mucormycosis; LABORATORY DIAGNOSIS; F-18-FDG PET/CT; EXENTERATION; HEALTH; MUCOR;

D O I：

10.4103/ijo.IJO_1565_21

中图分类号：

R77 [眼科学];

学科分类号：

100212 ;

摘要：

Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion: Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

引用

页码：1670 / 1692

页数：23

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