Clinical Presentations, Management and Outcomes of Rhino-Orbital-Cerebral Mucormycosis (ROCM) Following COVID-19: A Multi-Centric Study.
Clinical Presentations, Management and Outcomes of Rhino-Orbital-Cerebral Mucormycosis (ROCM) Following COVID-19: A Multi-Centric Study.
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DOI：
10.1097/iop.0000000000002030
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发表时间：
2021-09-01
影响因子：
2
通讯作者：
Bradoo RA
中科院分区：
文献类型：
--
作者：
Dave TV;Gopinathan Nair A;Hegde R;Vithalani N;Desai S;Adulkar N;Kamal S;Mittal R;Bradoo RA
报告COVID-19后鼻-眶-脑毛霉菌病的临床表现和影响结局的因素。鼻-眶-脑毛霉菌病58眼回顾性多中心介入病例系列。记录人口统计学、临床参数和管理结果。分析影响预后和死亡率的因素。当末次访视时观察到感染完全消退或稳定且无进一步进展时，结局定义为有利。平均年龄为55 ± 11岁（中位数56岁）。平均HbA 1c值为10.44 ± 2.84 mg%（中位数10.5）。确诊COVID-19和鼻-眶-脑毛霉菌病之间的时间间隔为16 ± 21天（中位数：8天）。36只眼（62%）就诊时无视力。影像学显示副鼻窦受累（100%），眶尖受累（41%），海绵窦受累（30%）和中枢神经系统（CNS）受累（33%）。所有患者均采用脂质体联合鼻窦清创术治疗。22只眼（38%）行眼球摘除术。一只眼接受经皮球后白细胞介素-B。平均随访时间为5.62 ± 0.78个月（中位数6个月）。在35例（60%）病例中观察到有利结局。存在未控制的糖尿病（p = 0.001）、眶尖受累（p = 0.04）、CNS受累（p = 0.04）和类固醇使用史（p < 0.0001）导致不良结局。CNS受累是预测死亡率的唯一因素（p = 0.03）。20例（34%）患者死亡。超过三分之一的COVID-19鼻眶脑毛霉菌病患者的临床结局不利。发病时未控制的糖尿病、累及眶尖、中枢神经系统和使用类固醇与预后较差相关。CNS受累是决定死亡率的因素。在58例COVID-19后鼻-眶-脑毛霉菌病患者中，35例（60%）患者的结局良好。不受控制的糖尿病、眶尖受累、海绵窦受累以及使用类固醇治疗COVID-19导致了不利的结局。
To report clinical presentations and factors affecting outcomes in rhino-orbital-cerebral mucormycosis following COVID-19. Retrospective multi-centric interventional case series of 58 eyes with rhino-orbital-cerebral mucormycosis. Demography, clinical parameters and management outcomes were noted. Factors affecting outcome and mortality were analyzed. Outcome was defined as favorable when complete resolution or stabilization without further progression of the infection was noted at last visit. Mean age was 55 ± 11 years (median 56). The mean HbA1c value was 10.44 ± 2.84 mg% (median 10.5). The duration between the diagnosis of COVID-19 and rhino-orbital-cerebral mucormycosis was 16 ± 21 days (median: 8 days). Thirty-six eyes (62%) had no vision at presentation. Imaging revealed paranasal sinus involvement (100%), orbital apex involvement (41%), cavernous sinus involvement (30%), and central nervous system (CNS) involvement (33%). All the patients were treated with systemic Liposomal amphotericin-B and sinus debridement. Twenty-two eyes (38%) underwent exenteration. One eye underwent transcutaneous retrobulbar amphotericin-B. The mean follow-up duration was 5.62 ± 0.78 months (median 6). Favorable outcome was seen in 35 (60%) cases. Presence of uncontrolled diabetes (p = 0.001), orbital apex involvement (p = 0.04), CNS involvement (p = 0.04), and history of steroid use (p < 0.0001) resulted in unfavorable outcome. CNS involvement was the only factor predicting mortality (p = 0.03). Mortality was seen in 20 (34%) patients. Over a third of patients with rhino-orbital-cerebral mucormycosis following COVID-19 have an unfavorable clinical outcome. Uncontrolled diabetes mellitus at presentation, involvement of the orbital apex, CNS, and the usage of steroids were associated with poorer outcomes. CNS involvement was a factor determining mortality. In 58 patients with rhino-orbital-cerebral mucormycosis post-COVID-19, favorable outcome was seen in 35 (60%) cases. Uncontrolled diabetes, orbital apex involvement, cavernous sinus involvement, and use of steroids for COVID-19, resulted in unfavorable outcome.