A retrospective review to assess the clinical outcome of rhino-orbito-cerebral mucormycosis patients with COVID-19 infection and its association with glycaemic control

ABSTRACT

Introduction: The coronavirus disease 2019 (COVID-19) pandemic in India, having caused 29 500 000 confirmed cases and 374 000 deaths as of June 14, 2021, continues to have devastating consequences, including a large epidemic of COVID-19-associated mucormycosis (COVID-Mucor), manifesting as rhino-orbito-cerebral mucormycosis (ROCM), which has worsened the morbidity among vulnerable populations (JHU, 2021) 1. Reports have shown a much larger surge in the incidence of COVID-Mucor during the second wave in 2021 than during the first wave (Patel et al., 2021, Moorthy et al., 2021) 2, 3. This rapid rise in COVID-Mucor is probably caused by several factors. For patients with diabetes mellitus, lockdowns, travel restrictions, and restricted access to medical care have worsened glycaemic control, the central risk factor for ROCM in India (Chakrabarti et al., 2006) 4. Addressing these could reduce morbidity and mortality among vulnerable populations. Material(s) and Method(s) A Retrospective chart review was conducted in Department of General medicine Dr S N Medical College Jodhpur among population included all rhinoorbito-cerebral mucormycosis patients with Covid-19 infection who were admitted in Mucormycosis ward, Dr S N Medical College Jodhpur from Oct. 2020 to Sept 2021. Bed head tickets of all these patients were reviewed. The final outcome was noted from the bed head ticket, the outcome was correlated with random blood sugar and HbA1c level at admission. Conclusion(s) Mucormycosis is angioinvasive fungal disease with significant morbidity and mortality. The disease has risen dramatically due to interplay of COVID 19 pandemic, uncontrolled diabetes and inappropriate corticosteroid use leading to pathogenic invasion and adverse outcomes. The treatment involves early detection, surgical debridement and antifungal drugs for better survival. Our study revealed an evident role of hyperglycemia as major risk factor for mucormycosis infection. Those patients who had HbA1c> 10 could not survive inspite of best treatment and those patients who survived their hospital stay was directly proportional to their HbA1c level. All those patients who had cerebral involvement could not be saved. Hence, we suggest that closely tracking the levels of blood sugar in COVID-19 patients is a valuable tool to stratify the risk that a patient will have mucormycosis. Copyright © 2022 Ubiquity Press. All rights reserved.