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Surgical & medical management of ROCM (Rhino-orbito-cerebral mucormycosis) epidemic in COVID-19 era and its outcomes – a tertiary care center experience - 18/05/22

Doi : 10.1016/j.mycmed.2021.101238 
Kapil Soni a, Aparna Das a, Vidhu Sharma a, Amit Goyal a, , Bikram Choudhury a, Ankita Chugh b, Deepak Kumar c, Taruna Yadav d, Vidhi Jain e, Ashwini Agarwal e, Mayank Garg f, Kavita Bhatnagar g, Poonam Elhence h, Pradeep Kumar Bhatia i, Mahendra Kumar Garg c, Sanjeev Misra j
a Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 
b Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 
c Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 
d Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 
e Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 
f Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 
g Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 
h Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 
i Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 
j Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India 

Corresponding author.

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Abstract

Objective

To evaluate the outcome of patients with ROCM (Rhino-orbito-cerebral mucormycosis) following their medical and surgical management.

Materials and methods

It is a prognostic study based in a tertiary care center in North-Western India. Patients who developed ROCM post COVID-19 infection from 1st September 2020 to 30th June 2021 were included in this study. Surgical debridement and administration of antifungal therapy was done for the post-COVID-19 ROCM patients. Disease progression and survival was studied up to 5 months of follow-up in the second wave.

Results

A total of 145 ROCM patients were included. The mean age at presentation, male: female ratio was 48.2 years and 2:1 respectively. As per our proposed new staging system and treatment strategy, the majority of patients belonged to stage II (31.72%) and stage III (31.03%). On a follow-up period of 5 months, 26 (18%) patients have lost their life and rest of the patients are on strict follow-up.

Conclusion

ROCM is an extremely aggressive fungal infection which rapidly became an epidemic following the COVID-19 pandemic. The diverse and unique presentation led us to evolve a new strategy to classify and manage these patients.

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Keywords : ROCM (rhino-orbito-cerebral mucormycosis), COVID-19, Staging protocol, Outcome, Treatment, Amphotericin


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© 2021  SFMM. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 32 - N° 2

Artículo 101238- mai 2022 Regresar al número
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