Novel Staging Protocol for Management of Post Covid Mucor Mycosis

Abstract

Introduction: There is an upsurge of Mucor Mycosis infection following Covid -19 pandemic. Disordered immune system due to covid19 infection coupled with indiscriminate use of steroids is believed to be responsible for this upsurge.Objectives: This study is aimed at analysing the preliminary epidemiological data of Mucormycosis patientsadmitted in a single tertiary care centre, stage them at presentation and to devise a treatment protocol according to their stage . To study the various surgical interventions, postoperative follow-up and treatment outcomes in terms of recovery rate and recurrence.Patients and Methods: This is a prospective longitudinal study, one of the largest of its kind involving around1841 patients diagnosed as Mucormycosis and admitted in a tertiary care hospital in India. A detailed case history, Diagnostic nasal endoscopy, CECT scan and MRI Scan were done. A novel staging was devised and patients were managed medically and surgically as per the stage. Debrided tissue was sent for microbiological and histopathological confirmation. Patients were followed-up and their recovery rates were analysed.Results: Among 1841 patients of mucor mycosis studied, 1288 were Rhino orbital and 78 were Rhino cerebraltype. 1229 patients under went surgical debridement according to the stage of disease, and rest were managed conservatively. Recovery rates fell from 90% to 26% from stage I to stage IV due to in volvement of CNS and Orbits. The mortality was as low as 17%. Re -do surgeries were done in only 12% of cases.Conclusion: Staging of mucor at presentation helps in planning, assessing response of treatment and prognosis.