Rhino-orbito-cerebral Mucormycosis: Etiopathology, Clinical Features, Outcome, and the Factors Associated with Outcome
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Purpose: Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology,clinical features, treatment outcome, and the factors associated with outcome in ROCM. Methods: Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings,treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures wereevaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identifyfactors associated with treatment outcome. Results: On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea,diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relativeafferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconalinvasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatmentoutcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation(aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferentpupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two ormore sinus involvement (aOR, 4.90; p = 0.009). Conclusions: The current study identified newer factors in the form of presenting ocular and radiological features as predictorsfor aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiatethese associations.
Abstract
Purpose: Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology,clinical features, treatment outcome, and the factors associated with outcome in ROCM. Methods: Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings,treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures wereevaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identifyfactors associated with treatment outcome. Results: On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea,diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relativeafferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconalinvasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatmentoutcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation(aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferentpupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two ormore sinus involvement (aOR, 4.90; p = 0.009). Conclusions: The current study identified newer factors in the form of presenting ocular and radiological features as predictorsfor aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiatethese associations.
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