Surgical management of COVID-19 associated rhino-orbito-cerebral-mucormycosis (Ca-Rocm): A single centre experience

Abstract

COVID-19 associated rhino-orbito-cerebral-mucormycosis (CA-ROCM) is a fulminant and life-threatening disease. Surgical intervention and prompt antifungal therapy are the mainstays of treatment. This is an observational, retrospective and a single centred study, on 24 active COVID19 and 50 post-COVID-19 patients, with ROCM respectively. The study was carried out from a period of May 1st 2021 till July 15th 2021 at a tertiary care hospital in South India. Patients were followed up for a period of 12 months for survival. A total of 74 COVID-19 patients with ROCM were included in our study. Of which 24 were active COVID-19 patients and 50 were post COVID-19 patients. The median age at presentation was 50 years, ranging from 31-75 years, 46 (62.2%) patients were males and 28(37.8%) were females. The average days from the diagnosis of COVID-19 to the appearance of symptom indicative of ROCM was 21.9 days, ranging from 4-51 days. Majority of patients belonged to stage IIC (43.24%) followed by stage IIB (23%) according to the staging system. Patients with >stage 3C had poor prognosis. The mortality was 8.1%. 8 patients underwent surgery for recurrence in the follow-up period. Early diagnosis, surgical debridement, anti-fungal treatment and close monitoring are the keys to management of CA-ROCM. A staging system aids in formulating an effective surgical plan for better survival outcomes.