Rhino-Orbital-Cerebral Mucormycosis: Clinico-Epidemiologic Study in a Regional Centre in Eastern India during the Second Wave of COVID-19 Pandemic

Introduction 
Rhino-orbital -cerebral mucormycosis (ROCM), a life-threatening acute fungal rhinosinusitis, has recently been reported in increasing numbers in post-COVID patients in the backdrop of uncontrolled hyperglycemia. We present our on-going experience with these patients.
Materials and Methods
A descriptive longitudinal study involving forty-three ROCM patients, during the 2nd wave of COVID -19, are presented here to discuss the epidemiology, clinical features, management approaches and outcomes.
Results 
Commoner in males (65%), most ROCM patients belonged to lower socio-economic status and 41-50 years age group. Eighty six percent patients were known diabetics and confirmed COVID-19 illness were present in and 53% patients. Advanced disease (Stage-3&4) was found in 54% of patients at presentation. Diagnosis was confirmed by fungal culture and histopathological evidence of tissue invasion.   All patients received injection Amphotericin B and undergone surgical debridement (endoscopic or external approach). Seventy two percent patients were discharged on oral antifungal post -debridement, 28% patients expired during course of treatment.
Conclusion
ROCM led to significant morbidity and mortality in post COVID patients due to its aggressive nature, late presentation and limited guidelines on management protocol. Early diagnosis in patients presented with suggestive background and a multidisciplinary team management approach is crucial.  Randomized control trials on efficacy of various treatment modalities with duration of antifungal treatment will help in better management of these patients.