Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1

• DOI: 10.4103/ijo.ijo_1565_21
• Publication Date: 2021-06-25T18:43:02Z
• Authors: Mrittika Sen; Santosh G Honavar; Rolika Bansal; Sabyasachi Sengupta; Raksha Rao; Usha Kim; Mukesh Sharma; Mahipal Sachdev; Ashok K Grover; Abhidnya Surve; Abhishek Budharapu; Abhishek K Ramadhin; Abhishek Kumar Tr...; Adit Gupta; Aditya Bhargava; Animesh Sahu; Anjali Khairnar; Anju Kochar; Ankita Madhavani; Ankur K Shrivastava; Anuja K Desai; Anujeet Paul; Anuradha Ayyar; Aparna Bhatnagar; Aparna Singhal; Archana Sunil Nikose; Arun Bhargava; Arvind L Tenagi; Ashish Kamble; Ashiyana Nariani; Bhavin Patel; Bibbhuti Kashyap; Bodhraj Dhawan; Busaraben Vohra; Charuta Mandke; Chinmayee Thrishu...; Chitra Sambare; Deepayan Sarkar; Devanshi Shirishb...; Dhwani Maheshwari; Dilip Lalwani; Dipti Kanani; Diti Patel; Fairooz P Manjand...; Frenali Godhani; Garima Amol Agarwal; Gayatri Ravulaparthi; Gondhi Vijay Shilpa; Gunjan Deshpande; Hansa Thakkar; Hardik Shah; Hare Ram Ojha; Harsha Jani; Jyoti Gontia; Jyotika P Mishrik...; Kamalpreet Likhari; Kamini Prajapati; Kavita Porwal; Kirthi Koka; Kulveer Singh Dha...; Lakshmi B Ramamurthy; Mainak Bhattacharyya; Manorama Saini; Marem C Christy; Mausumi Das; Maya Hada; Mehul Panchal; Modini Pandharpurkar; Mohammad Osman Ali; Mukesh Porwal; Nagaraju Gangashe...; Neelima Mehrotra; Neha Bijlani; Nidhi Gajendragadkar; Nitin M Nagarkar; Palak Modi; Parveen Rewri; Piyushi Sao; Prajakta Salunkhe...; Pramod Giri; Priti Kapadia; Priti Yadav; Purvi Bhagat; Ragini Parekh; Rajashekhar Dyaberi; Rajender Singh Ch...; Rajwinder Kaur; Ram Kishan Duvesh; Ramesh Murthy; Ravi Varma Dandu; Ravija Kathiara; Renu Beri; Rinal Pandit; Rita Hepsi Rani; Roshmi Gupta; Ruchi Pherwani; Rujuta Sapkal; Rupa Mehta; Sameeksha Tadepalli; Samra Fatima; Sandeep Karmarkar; Sandeep Suresh Patil; Sanjana Shah; Sankit Shah; Sapan Shah; Sarika Dubey; Saurin Gandhi; Savitha Kanakpur; Shalini Mohan; Sharad Bhomaj; Sheela Kerkar; Shivani Jariwala; Shivati Sahu; Shruthi Tara; Shruti Kochar Maru; Shubha Jhavar; Shubhda Sharma; Shweta Gupta; Shwetha Kumari; Sima Das; Smita Menon; Snehal Burkule; Sonam Poonam Nisar; Subashini Kaliape...; Subramanya Rao; Sudipto Pakrasi; Sujatha Rathod; Sunil G Biradar; Suresh Kumar; Susheen Dutt; Svati Bansal; Swati Amulbhai Ra...; Sweta Lohiya; Syed Wajahat Ali ...; Tanmay Gokhale; Tatyarao P Lahane; Tejaswini Vukkadala; Triveni Grover; Trupti Bhesaniya; Urmil Chawla; Usha Singh; Vaishali L Une; Varsha Nandedkar; Venkata Subramaniam; Vidya Eswaran; Vidya Nair Chaudhry; Viji Rangarajan; Vipin Dehane; Vivek M Sahasrabudhe; Yarra Sowjanya; Yashaswini Tupkary; Yogita Phadke
• Keywords: 2019-20 coronavirus outbreak

COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, including comorbidities, and medications used treat COVID-19, presenting symptoms signs, outcome management. was a retrospective, observational patients ROCM managed or co-managed by ophthalmologists India from January 1, 2020 May 26, 2021. Of 2826 patients, states Gujarat (22%) Maharashtra (21%) reported highest number ROCM. The mean age 51.9 years male preponderance (71%). While 57% needed oxygen support for infection, 87% were treated corticosteroids, (21% > 10 days). Diabetes mellitus (DM) present 78% all patients. Most cases showed onset between day 15 diagnosis 56% developed within 14 days after diagnosis, while 44% had delayed beyond days. Orbit involved 72% stage 3c forming bulk (27%). Overall treatment included intravenous amphotericin B 73%, functional endoscopic sinus surgery (FESS)/paranasal (PNS) debridement 56%, orbital exenteration 15%, both FESS/PNS 17%. Intraorbital injection administered 22%. At final follow-up, mortality 14%. Disease >3b poorer prognosis. Paranasal reduced rate 52% 39% 4 disease intracranial extension (p < 0.05). : Corticosteroids DM are most important predisposing development must be followed up recovery. Awareness red flag high index clinical suspicion, prompt early initiation B, aggressive surgical PNS, exenteration, where indicated, essential successful outcome.