Ocular exenteration in rhino-orbito-cerebral mucormycosis
Abstract Introduction: Mucormycosis is a very aggressive infection generated by aerobic fungi that can involve the upper airway and spread to adjacent structures. Objective: To analyze the association between death and ocular exenteration in patients with rhino-orbito-cerebral mucormycosis. Method: The clinical aspects and outcome of patients with rhino-orbito-cerebral mucormycosis were analyzed. Descriptive statistics were used, Chi square was used for association, odd ratio was used for risk, considering a value of p≤0.05 as significant. Results: Of 45, 11 did not meet the inclusion criteria, no associations were found between sex, diabetes with other comorbidities, MROC stages and death, COVID-19 infection, or glycated hemoglobin (HbA1c). However, bone lysis on tomography (p=0.001), type of surgical procedure (p=0.002), and ocular exenteration (p=0.001) were significantly associated with death. Differences were found between C-reactive protein (CRP) levels (p=0.035), erythrocyte sedimentation rate (ESR) (p=0.056), and absolute neutrophil count (p=0.000) with death. Discussion: The decision to undergo ocular exenteration is a complex aspect in patients with MROC. There are authors who point out that the psychological impact is significant in a substantial proportion of patients. Conclusions: The only characteristics associated with death in patients with MROC in the study were the presence of bone lysis on the tomography and ocular exenteration.
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Cámara López D, Reyes Castañeda EG, Cabrera Arévalo CE, Calvillo Rivera JG, Alonso Moctezuma A, Cámara López D, et al. Mucormicosis rino-órbito-cerebral: casuística en un hospital de tercer nivel en méxico, en 3 años. Rev Esp Cir Oral Maxilofac. 2022;44(1):23-29.
Rahal EM, Moreno VM, Villa NJ. Mucormicosis rino-orbito-cerebral: Experiencia en doce años. Rev Otorrinolaringol Cir Cabeza Cuello. 2008;68(1):27-34.
Bravo JH, Agudelo AM, Cortés A, Matta L. Rhino-orbito-cerebral mucormycosis from dental origin: Case report. Biomed Rev Inst Nac Salud. 2018;38(1):27-31.
Solano L, Morillo G, Gómez F, Díaz I, Mago H. Mucormicosis Rino-Orbito Cerebral En Paciente Con Diagnostico Presuntivo De COVID 19. Bol Venez Infectol. 2021;32(2). Disponible en: https://boletinsvi.com/
Raman M, Alagappan Y, Kumar NKS. Role of orbital exenteration in management of rhino-orbito-cerebral mucormycosis (ROCM) - A prospective analytical study. IP Int J Ocul Oncol Oculoplasty. 2022;8(3):185-189.
Piromchai P, Thanaviratananich S. Impact of treatment time on the survival of patients suffering from invasive fungal rhinosinusitis. Clin Med Insights Ear Nose Throat. 2014;7:31-34.
Singh VP, Bansal C, Kaintura M. Sinonasal Mucormycosis: A to Z. Indian J Otolaryngol Head Neck Surg Off Publ Assoc Otolaryngol India. noviembre de 2019;71(Suppl 3):1962-1971.
Levinsen M, Kiilgaard JF, Thomsen C, Heegaard S, Nissen KR. Medical and surgical treatment of rhino-orbital-cerebral mucormycosis in a child with leukemia. Am J Ophthalmol Case Rep. 2021;22:101092.
Vironneau P, Kania R, Herman P, Morizot G, Garcia-Hermoso D, Lortholary O, et al. Local control of rhino-orbito-cerebral mucormycosis dramatically impacts survival. Clin Microbiol Infect. 2014;20(5): 336-339.
Jumaily M, Faraji F, Brunworth JD. Endoscopic orbital exenteration in the treatment of acute invasive fungal sinusitis. Acta Oto-Laryngol Case Rep. 1 de enero de 2016;1(1):58-62.
Safi M, Ang MJ, Patel P, Silkiss RZ. Rhino-orbital-cerebral mucormycosis (ROCM) and associated cerebritis treated with adjuvant retrobulbar amphotericin B. Am J Ophthalmol Case Rep. 2020;19:100771.
Murthy R, Bagchi A, Gote Y, Desai S. Retrobulbar injection of amphotericin B using intravenous cannula for post-COVID-19 rhino-orbital mucormycosis. Indian J Ophthalmol. 2022;70(1):302-305.
Singh P, Gupta A, Sanepalli SR, Raj A. Transcutaneous retrobulbar amphotericin-B (TRAMB) injection in orbital mucormycosis. BMJ Case Rep. 31 de marzo de 2022;15(3):e246307.
Hirabayashi KE, Kalin-Hajdu E, Brodie FL, Kersten RC, Russell MS, Vagefi MR. Retrobulbar Injection of Amphotericin B for Orbital Mucormycosis. Ophthal Plast Reconstr Surg. 2017;33(4):e94-7.
Sharifi A, Akbari Z, Shafie’ei M, Nasiri N, Sharifi M, Shafiei M, et al. Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review. Ophthal Plast Reconstr Surg. 2022;38(5):425-432.
Chakravarty J, Gupta MK, Tilak R, Kumar R, Maurya RP, Kumar N, et al. COVID-19-associated Mucormycosis: A clinico-epidemiological study. J Diabetes Complications. 2022;36(9):108284.
Maurya RP. Indications for orbital exenteration in COVID-19 associated Rhino-orbito-cerebral Mucormycosis. IP Int J Ocul Oncol Oculoplasty. 2021;7(2):105-108.
Honavar SG. Code Mucor: Guidelines for the Diagnosis, Staging and Management of Rhino-Orbito-Cerebral Mucormycosis in the Setting of COVID-19. Indian J Ophthalmol. 2021;69(6):1361-1365.
Talmi YP, Goldschmied-Reouven A, Bakon M, Barshack I, Wolf M, Horowitz Z, et al. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2002;127(1):22-31.
Szekanecz Z, Vályi-Nagy I. Post-acute COVID-19 syndrome. Orv Hetil. 2021;162(27):1067-1078.
Bhattacharyya A, Sarma P, Sharma DJ, Das KK, Kaur H, Prajapat M, et al. Rhino-orbital-cerebral-mucormycosis in COVID-19: A systematic review. Indian J Pharmacol. 2021;53(4):317-327.
Watanabe A, So M, Mitaka H, Ishisaka Y, Takagi H, Inokuchi R, et al. Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis. Mycopathologia. 2022;187(2-3):271-289.
Hargrove RN, Wesley RE, Klippenstein KA, Fleming JC, Haik BG. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg. 2006;22(4):286-291.
Turner JH, Soudry E, Nayak JV, Hwang PH. Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. The Laryngoscope. 2013;123(5):1112-1118.
Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol. 2021;135(5):442-447.
Mishra N, Mutya VSS, Thomas A, Rai G, Reddy B, Mohanan AA, et al. A case series of invasive mucormycosis in patients with COVID-19 infection. Int J Otorhinolaryngol Head Neck Surg. 2021;7(5):867-870.
Deb AK, Singh R, Kaliaperumal S, Alexander A, Gokhale T, Sarkar S. Rhino-orbito-cerebral Mucormycosis: Etiopathology, Clinical Features, Outcome, and the Factors Associated with Outcome. Korean J Ophthalmol KJO. 2022;36(4):356-365.
Ackuaku-Dogbe EM, Biritwum RB, Briamah ZI. Psycho-Social Challenges Of Patients Following Orbital Exenteration. East Afr Med J. 2012;89(12):385-389.
Shah K, Dave V, Bradoo R, Shinde C, Prathibha M. Orbital Exenteration in Rhino-Orbito-Cerebral Mucormycosis: A Prospective Analytical Study with Scoring System. Indian J Otolaryngol Head Neck Surg Off Publ Assoc Otolaryngol India. 2019;71(2):259-265.
Sharma, A., Goel, A. Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic. Folia Microbiol. 2022;67:363–387.
Tayabali K, Pothiwalla H, Narayanan S. Epidemiology of COVID-19-Associated Mucormycosis. Curr Fungal Infect Rep. 2023:1-20. https://doi.org/10.1007/s12281-023-00464-2.
Hoenigl M, Seidel D, Carvalho A, Rudramurthy SM, Arastehfar A, Gangneux JP, Nasir N, Bonifaz A, Araiza J, Klimko N, Serris A, Lagrou K, Meis JF, Cornely OA, Perfect JR, White PL, Chakrabarti A; ECMM and ISHAM collaborators. The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries. Lancet Microbe. 2022;3(7):e543-e552. https://doi.org/10.1016/S2666-5247(21)00237-8.
Dam P, Cardoso MH, Mandal S, Franco OL, Sağıroğlu P, Polat OA, Kokoglu K, Mondal R, Mandal AK, Ocsoy I. Surge of mucormycosis during the COVID-19 pandemic. Travel Med Infect Dis. 2023;52:102557. https://orcid.org/10.1016/j.tmaid.2023.102557.
Niranjan Nayak, Erum Khan, Debadatta Panigrahi, "COVID-19 and Mucormycosis Coinfection: How Challenging It Is", Canadian Journal of Infectious Diseases and Medical Microbiology. 2022;8617212:5. https://doi.org/10.1155/2022/8617212
Rahal EM, Moreno VM, Villa NJ. Mucormicosis rino-orbito-cerebral: Experiencia en doce años. Rev Otorrinolaringol Cir Cabeza Cuello. 2008;68(1):27-34.
Bravo JH, Agudelo AM, Cortés A, Matta L. Rhino-orbito-cerebral mucormycosis from dental origin: Case report. Biomed Rev Inst Nac Salud. 2018;38(1):27-31.
Solano L, Morillo G, Gómez F, Díaz I, Mago H. Mucormicosis Rino-Orbito Cerebral En Paciente Con Diagnostico Presuntivo De COVID 19. Bol Venez Infectol. 2021;32(2). Disponible en: https://boletinsvi.com/
Raman M, Alagappan Y, Kumar NKS. Role of orbital exenteration in management of rhino-orbito-cerebral mucormycosis (ROCM) - A prospective analytical study. IP Int J Ocul Oncol Oculoplasty. 2022;8(3):185-189.
Piromchai P, Thanaviratananich S. Impact of treatment time on the survival of patients suffering from invasive fungal rhinosinusitis. Clin Med Insights Ear Nose Throat. 2014;7:31-34.
Singh VP, Bansal C, Kaintura M. Sinonasal Mucormycosis: A to Z. Indian J Otolaryngol Head Neck Surg Off Publ Assoc Otolaryngol India. noviembre de 2019;71(Suppl 3):1962-1971.
Levinsen M, Kiilgaard JF, Thomsen C, Heegaard S, Nissen KR. Medical and surgical treatment of rhino-orbital-cerebral mucormycosis in a child with leukemia. Am J Ophthalmol Case Rep. 2021;22:101092.
Vironneau P, Kania R, Herman P, Morizot G, Garcia-Hermoso D, Lortholary O, et al. Local control of rhino-orbito-cerebral mucormycosis dramatically impacts survival. Clin Microbiol Infect. 2014;20(5): 336-339.
Jumaily M, Faraji F, Brunworth JD. Endoscopic orbital exenteration in the treatment of acute invasive fungal sinusitis. Acta Oto-Laryngol Case Rep. 1 de enero de 2016;1(1):58-62.
Safi M, Ang MJ, Patel P, Silkiss RZ. Rhino-orbital-cerebral mucormycosis (ROCM) and associated cerebritis treated with adjuvant retrobulbar amphotericin B. Am J Ophthalmol Case Rep. 2020;19:100771.
Murthy R, Bagchi A, Gote Y, Desai S. Retrobulbar injection of amphotericin B using intravenous cannula for post-COVID-19 rhino-orbital mucormycosis. Indian J Ophthalmol. 2022;70(1):302-305.
Singh P, Gupta A, Sanepalli SR, Raj A. Transcutaneous retrobulbar amphotericin-B (TRAMB) injection in orbital mucormycosis. BMJ Case Rep. 31 de marzo de 2022;15(3):e246307.
Hirabayashi KE, Kalin-Hajdu E, Brodie FL, Kersten RC, Russell MS, Vagefi MR. Retrobulbar Injection of Amphotericin B for Orbital Mucormycosis. Ophthal Plast Reconstr Surg. 2017;33(4):e94-7.
Sharifi A, Akbari Z, Shafie’ei M, Nasiri N, Sharifi M, Shafiei M, et al. Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review. Ophthal Plast Reconstr Surg. 2022;38(5):425-432.
Chakravarty J, Gupta MK, Tilak R, Kumar R, Maurya RP, Kumar N, et al. COVID-19-associated Mucormycosis: A clinico-epidemiological study. J Diabetes Complications. 2022;36(9):108284.
Maurya RP. Indications for orbital exenteration in COVID-19 associated Rhino-orbito-cerebral Mucormycosis. IP Int J Ocul Oncol Oculoplasty. 2021;7(2):105-108.
Honavar SG. Code Mucor: Guidelines for the Diagnosis, Staging and Management of Rhino-Orbito-Cerebral Mucormycosis in the Setting of COVID-19. Indian J Ophthalmol. 2021;69(6):1361-1365.
Talmi YP, Goldschmied-Reouven A, Bakon M, Barshack I, Wolf M, Horowitz Z, et al. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2002;127(1):22-31.
Szekanecz Z, Vályi-Nagy I. Post-acute COVID-19 syndrome. Orv Hetil. 2021;162(27):1067-1078.
Bhattacharyya A, Sarma P, Sharma DJ, Das KK, Kaur H, Prajapat M, et al. Rhino-orbital-cerebral-mucormycosis in COVID-19: A systematic review. Indian J Pharmacol. 2021;53(4):317-327.
Watanabe A, So M, Mitaka H, Ishisaka Y, Takagi H, Inokuchi R, et al. Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis. Mycopathologia. 2022;187(2-3):271-289.
Hargrove RN, Wesley RE, Klippenstein KA, Fleming JC, Haik BG. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg. 2006;22(4):286-291.
Turner JH, Soudry E, Nayak JV, Hwang PH. Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. The Laryngoscope. 2013;123(5):1112-1118.
Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol. 2021;135(5):442-447.
Mishra N, Mutya VSS, Thomas A, Rai G, Reddy B, Mohanan AA, et al. A case series of invasive mucormycosis in patients with COVID-19 infection. Int J Otorhinolaryngol Head Neck Surg. 2021;7(5):867-870.
Deb AK, Singh R, Kaliaperumal S, Alexander A, Gokhale T, Sarkar S. Rhino-orbito-cerebral Mucormycosis: Etiopathology, Clinical Features, Outcome, and the Factors Associated with Outcome. Korean J Ophthalmol KJO. 2022;36(4):356-365.
Ackuaku-Dogbe EM, Biritwum RB, Briamah ZI. Psycho-Social Challenges Of Patients Following Orbital Exenteration. East Afr Med J. 2012;89(12):385-389.
Shah K, Dave V, Bradoo R, Shinde C, Prathibha M. Orbital Exenteration in Rhino-Orbito-Cerebral Mucormycosis: A Prospective Analytical Study with Scoring System. Indian J Otolaryngol Head Neck Surg Off Publ Assoc Otolaryngol India. 2019;71(2):259-265.
Sharma, A., Goel, A. Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic. Folia Microbiol. 2022;67:363–387.
Tayabali K, Pothiwalla H, Narayanan S. Epidemiology of COVID-19-Associated Mucormycosis. Curr Fungal Infect Rep. 2023:1-20. https://doi.org/10.1007/s12281-023-00464-2.
Hoenigl M, Seidel D, Carvalho A, Rudramurthy SM, Arastehfar A, Gangneux JP, Nasir N, Bonifaz A, Araiza J, Klimko N, Serris A, Lagrou K, Meis JF, Cornely OA, Perfect JR, White PL, Chakrabarti A; ECMM and ISHAM collaborators. The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries. Lancet Microbe. 2022;3(7):e543-e552. https://doi.org/10.1016/S2666-5247(21)00237-8.
Dam P, Cardoso MH, Mandal S, Franco OL, Sağıroğlu P, Polat OA, Kokoglu K, Mondal R, Mandal AK, Ocsoy I. Surge of mucormycosis during the COVID-19 pandemic. Travel Med Infect Dis. 2023;52:102557. https://orcid.org/10.1016/j.tmaid.2023.102557.
Niranjan Nayak, Erum Khan, Debadatta Panigrahi, "COVID-19 and Mucormycosis Coinfection: How Challenging It Is", Canadian Journal of Infectious Diseases and Medical Microbiology. 2022;8617212:5. https://doi.org/10.1155/2022/8617212
Lugo-Machado, J. A., Gutiérrez-Pérez, M. L., Zazueta-Cárdenas, A., Hernández-Sánchez, Y., Medina-Valentón, E., & García-Ramírez, P. E. (2024). Ocular exenteration in rhino-orbito-cerebral mucormycosis. Revista ORL, 15(2), e31941. https://doi.org/10.14201/orl.31941
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