MANAGEMENT AND FUNCTIONAL OUTCOME OF SARS COVID-19 INDUCED RHINO ORBITAL CEREBRAL MUCORMYCOSIS

Abstract

Background: Rhino-orbital cerebral mucormycosis(ROCM) is an uncommon infection caused by the angiotropic fungus belonging to the order Mucorales and has high morbidity and mortality despite treatment. Rhino-orbital cerebral mucormycosis almost always occurs in immunocompromised hosts, including patients with uncontrolled diabetes mellitus, hematologic cancers, and solid organ or hematopoietic stem cell transplants. The suspicion or diagnosis of rhino-orbital cerebral mucormycosis triggers a medical as well as surgical emergency with the delay in treatment, increasing morbidity and mortality. Aim: 1.outcome of medical management 2.functional outcome and evaluation after medical management 3.complications of mucormycosis 4.outcome after surgical management Methods: 62 SARS covid-19 cases were evaluated who were diagnosed with rhino orbital cerebral mucormycosis.most of the patients presented with ptosis.proptosis.orbital cellulitis,decreased visual acuity,sluggishly reacting pupils, restricted extraocularmovemets.some patients were known diabetics and some diagnosed with diabetes after COVID 19 reovery.Retrobulbar Liposomal Amphotercin –B(3.5mg) was given to all patients for 10 alternate days and simultaneously patients received IV LIPOSOMAL AMPHOTERCIN 300mg OD for 10days renal function tests were monitored. 54 of them improved on day 5 of injection most patient Results: s visual acuity improved from CF –CF to CF>6mts, patients with perception of light didn't show any improvement in visual acuity but ptosis,proptosis,conjunctival congestion and chemosis was improved and 10 patients underwent exenteration. ROCM is seen Conclusion: in most SARS COVID 19 who were known diabetics or post covid -19 induced uncontrolled high sugars most patients received high dose of steroids during covid 19 treatment.most patient showed improvement of symptoms after retrobulbar IV Amphotericin 3.5mg and improvement is observed on MRI stages too and some patients underwent exenteration which prevented furthurer spread of infection