Surgical Debridement in Patients of Rhinocerebral Mucormycosis (RCM) Post COVID-19: A Prospective Study

Abstract

Rhinocerebral mucormycosis (RCM) is an angioinvasive fungal infection, in which infection of the nasal and sinus walls may secondarily invade the orbit, skull base, and brain. RCM carries high mortality up to 46 % in patients with sinus involvement and 62 % in patients with rhinocerebral involvement. The diagnosis of RCM and assessment of the resection margins are based on histopathology, specific cultures, and/or PCR detection of Mucorales species. It was a prospective, longitudinal study conducted under neurosurgery department in Basaveshwara Medical College and Hospital, Chitradurga, Karnataka during 1st May to 30th June 2021. All patients with radiologically, clinically diagnosed & biopsy proven by samples collected intraoperatively are included in the study. Caldwell luc approach was employed for maxillary sinus debridement, FESS for pansinusitis cases & Craniotomy for cases with intracranial involvement. In this study, we found that age, gender, neutrophil counts, monocyte count, ferritin levels, CT severity, diabetic status and usage of steroids and oxygen had a major role in the pathogenesis of mucormycosis. IHC was done and genetic studies were sent. The surgical treatment of RCM requires early diagnosis & aggressive surgical debridement. The outcome of the aggressive debridement was good. The debridement should be continued until clear resection margins are obtained based on the assessment of microscopical findings of hyphae, fungal cultures, and/or fungal DNA detected by PCR. Keywords: Surgical debridement, Rhinocerebral Mucormycosis (RCM), Post COVID-19