Surgical Outcome of Rhinocerebral Mucormycosis in Corona Virus Associated Patient: A Prospective Study from a Tertiary Care Center in Eastern India

ABSTRACT

INTRODUCTION: Second wave of covid19 affected India significantly with total numbers of cases 31,440,950 and total death 4,21,224. As India acheived stablity in fight against covid, another challenge emerged in the form of Mucormycosis. Mucormycosis is a serious angioinvasive infection caused by the order Mucorales and class of Mucormycetes. It is associated with high mortality in immunocompromised mainly diabetic patients if not treated agressively. METHODS: Our Hospital, IGIMS was declared exclusive covid facility in April 2021 and subsequently was declared dedicated hospital for Mucormycosis.During this two month period demographic, Clinical details and outcome were collected prospectively. RESULTS: During two month period, 500 cases were seen in OPD, 300 patients were admitted and 120 patients were operated. 47 patients have cerebral involvement. 11 patients with extensive involvement of brain including cavernous sinus were not offered surgery, because of poor pronosis. 4 patients of this group improved 5 patients died and 2 patients were discharged in moribund condition. Another 26 patients with only meningeal involvement and small lesion, with no mass effect and was treated conservatively. 16 of this group improved, Four (with poor coma score expired. Another 4 patients were transferred to other medical facilities and details of these patients are not available. 10 patients having large fungal lesion in non eloquent area along with mass effect were operated. six patients were operated with microscopic technique and 4 patients with endoscopic technique. eight patients were earlier, Covid RT-PCR positive and was treated with steroid and oxygen inhalation. Another two patient had fever , but Covid RT-PCR was negative and was treated at home with oxygen cylinder.All of them were treated with liposomal amphotrecin B. Sinus surgery was performed in all patients. Eight patient did well and was discharged from hospital in good condition. One patient, in which endoscopic cerebral exploration was done expired. Another patient was discharged with severe neurological sequlae. CONCLUSIONS: Patients with Rhincerebral Mucormycosis spreading outside sinonasal cavity to the base of the brain can be treated by neurosurgical intervention.