Multidisciplinary Management of COVID-Associated Mucormycosis Syndemic in India

Indian Journal of Surgery - Tập 84 - Trang 934-942 - 2021
Rupa Mehta1, Nitin M. Nagarkar2, Atul Jindal3, Karthik Nagaraja Rao4, S. B. Nidhin1, Ripu Daman Arora1, Anil Sharma5, Archana Wankhede6, Satish Satpute1, Sharmistha Chakravarty1, N. K. Agrawal7, Pranita8, Pankaj Kannauje8, Ajoy Behera9, Pugazhenthan Thangaraju10
1Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India
2Director and CEO, All India Institute of Medical Sciences, Raipur, India
3DM Pediatric Critical care, All India Institute of Medical Sciences, Raipur, India
4MCh Head Neck Surgery and Oncology, Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India
5Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, India
6Department of Microbiology, All India Institute of Medical Sciences, Raipur, India
7Department of Anaesthesiology, All India Institute of Medical Sciences, Raipur, India
8Department of General Medicine, All India Institute of Medical Sciences, Raipur, India
9Department of Pulmonology, All India Institute of Medical Sciences, Raipur, India
10Department of Pharmacology, All India Institute of Medical Sciences, Raipur, India

Tóm tắt

The study aimed to determine clinical presentation, contributing factors, medical and surgical management, and outcome of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM). A cross-sectional, single-center study was conducted on patients receiving multidisciplinary treatment for mucormycosis following the second wave of COVID-19 pandemic from April to June 2021 in India. Clinicoepidemiological factors were analyzed, 30-day overall survival and disease-specific survival were determined, and t-test was used to determine the statistical significance. A total of 215 patients were included in the study, the cases were stratified into sino-nasal 95 (44.2%), sino-naso-orbital 32 (14.9%), sino-naso-palatal 55 (25.6%), sino-naso-cerebral 12 (5.6%), sino-naso-orbito-cerebral 16 (7.4%), and sino-naso-orbito-palato-cerebral 5 (2.3%) based on their presentation. A multidisciplinary team treated patients by surgical wound debridement and medical therapy with broad-spectrum antibiotics and amphotericin B. Across all disease stages, cumulative 30-day disease-specific survival is 94% (p < 0.001, intergroup comparison, Breslow (generalized Wilcoxon) CI 95%) and overall 30-day survival is 87.9% (p < 0.001, intergroup comparison, Breslow (generalized Wilcoxon) CI 95%) (censored). Early identification, triaging, and proper multidisciplinary team management with systemic antifungals, surgical debridement, and control of comorbidities lead to desirable outcomes in COVID-associated mucormycosis. The patients with intracranial involvement have a higher chance of mortality compared to the other group.

Tài liệu tham khảo

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