Turbinates involvment in rhino orbital cerebral mucormycosis in covid positive cases - A study on 100 cases

Abstract

Mucormycosis also called as zygomycosis previously refers to several different diseases caused by infection with fungi belonging to the order Mucorales. Rizopus species are the most common causative organism. The infections are life threatening. Risk factors such as Diabetic Ketoacidosis and Neutropenia are present in most cases. During the pandemic period of COVID-19 2 wave rhino orbital mucormycosis was commonly effected with probable reasons are due to over dosage of steroid usage and o2 therapy, Uncontroled diabetes etc. To know the percentage of involvement of turbinates (MT,IT)in Rhino orbito cerebral mucormycosis cases in covid positive patients by doing endoscopic sinus surgery. A total of 100 covid positive patients with ROMM were selected and taken for radiological evaluation and selected for ESS during intraoperatively turbinates involvement with mucor (eschar/pus/crusting) was noted diagnosis of ROMM was based on CECT findings and symptoms in covid positive cases. Patients who are attending to Gandhi hospital during the pandemic of 2 wave of covid 19 were selected in study. Common age group with ROMM are 36to 55 years, with male predominance, commonest symptoms are unilateral facial pain & swelling, nasal crusting and dental complaints, commonest sinus to be involved is maxillary sinus, comorbid condition is Diabetes mellitus and moderate percentage of involvement of turbinates(common is middle turbinate) were noted. On microbiological and pathological examination of specimen showed positive KOH mount and mucorales order fungi are common followed by rizopus species. Main conclusions in this study are turbinates involvement with mucor in covid positive cases (eschar/necrosis/pus discharge) is more common in 43 patients (43%), most common mucor pathology seen in maxillary sinus in 58 patients(58%),followed by ethmoid sinus and sphenoid and orbit, teeth.