Abstract
Aim: Rhino-Orbito-Cerebral Mucormycosis (ROCM) is an invasive fungal infection. An under diagnosed and underreported disease in India, it is rapidly fatal without an early diagnosis and treatment. We report the survival rate in our hospital, significant association with sinus involvement and therapy Methods: The clinical and laboratory data collected retrospectively from patients with a diagnosis of invasive zygomycosis, over a four and half year period (January 2015-July 2019) were combined and analysed from medical records. We analyzed clinical features, results of laboratory and radiological examinations, nasal endoscopy, treatment management outcomes of all cases. Results: A total of sixteen cases of invasive ROCM were diagnosed and treated at St Stephens Hospital, Delhi, from January 2015 to July 2019 of which ten were males (62.5%). All were diabetic (100%), DKA (Diabetic Keto Acidosis) and renal impairment was seen in 11 (68.75%) patients. All were given L-Amphotericin B (100%). Thirteen (81.2%) cases underwent surgical procedure. Duration of treatment with L-Amphotericin was significantly associated with improved outcomes (p=0.03). Maxillary and ethmoid sinus involvement was significantly associated with improved outcomes (p=0.02). Diagnosis was based on direct microscopic findings, mycology culture and histopathology findings (EORTC/MSG Consensus Group). Survival rate was 57.25% (9 improved and 7 expired). Conclusion: Duration of treatment with L Amphotericin and maxillary sinus involvement were associated with improved outcomes. In an otherwise lethal disease, rapid administration of Amphotericin B with surgery can go a long way in improving the survival rate in proven/probable mucormycosis.
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