Mortality and its determinants after an outbreak of post COVID-19 associated Rhino - Orbito - Cerebral mucormycosis in India 

Abstract

AIM: To report cumulative mortality rates using survival analysis from an outbreak of 211 patients with post COVID-19 rhino-orbito-cerebral mucormycosis (ROCM) in central India.METHODS: Case files of eligible patients were evaluated and mucor was identified from deep nasal swabs using freshly prepared KOH mount. All patients underwent contrast enhanced MRI and disease staging was done based on the extent of anatomical involvement. All patients received intravenous Amphotericin B and sinus debridement was done when possible. Orbital exenteration was reserved for patients with advanced orbital disease.RESULTS: The mean age was 50.7+10.2 of which 147 (70%) were men. At presentation, ROCM was limited to sinuses in 72 (34%), orbital extension was seen in 102 (48%) and 31 (15%) had CNS extension. Sinus debridement was possible in 82% cases (n=173). Thirty-five (16.6%) patients died due to ROCM. The mean follow-up of patients who survived was 126.6+16.4 days. The cumulative mortality rate at day 10 was 4.8% (95%CI=2.6 – 8.8%) and increased 13.1% (95%CI=9.1 – 18.7%) at day 30 and to 18.4% (95%CI=13.6 – 24.8%) at day 60. Majority of deaths (n=26, 75%) occurred within 1-month of ROCM presentation. Multivariable hazards analysis showed that patients with CNS involvement had a 6.5 times higher risk of death (Hazard Ratio =6.71, 95% CI=2.9 – 15.5, p<0.001). CONCLUSION: We report significantly lower mortality rates compared to recent literature that varies from 30 to 80% at 1-month follow up. Timely sinus debridement and systemic Amphotericin B can help reduce mortality. Presence of CNS extension significantly increased the mortality risk with patients with ROCM.