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Abstract：
Rhino orbital cerebral mucormycosis (ROCM) is an important infectious disease encountered in large numbers in this recent post-COVID-19 era. An alteration in the defense immune system during COVID-19 illness; in the presence of uncontrolled hyperglycemia has led to the new epidemic of ROCM, especially in developing nations such as India. This case series of thirteen patients illustrates the various clinical presentations, laboratory parameters, imaging features and outcomes of patients with ROCM admitted to a tertiary care hospital in Northern India. In our case series, a total of 13 newly diagnosed cases of rhino-orbital-cerebral mucormycosis were studied. A history of COVID-19 illness was observed in seven cases (53.8%) with a mean duration of mucormycosis after 25 ± 3.6 days, the use of steroids during COVID-19 illness was seen in 5 cases (38.5%), and oxygen therapy was given in 4 cases (30.8%). A comorbid state in the form of diabetes mellitus was present in 12 cases (92.3%) with a mean duration of 16.69 months, with an important finding of seven cases (53.85%) having new-onset diabetes; hypertension was present in three cases (23.1%). Magnetic resonance imaging of paranasal sinuses showed involvement of multiple sinuses in all 13 cases (100%), including maxillary and ethmoidal sinuses, with frontal involvement in 12 cases (92.3%), sphenoidal involvement in 11 cases (84.6%), symmetric involvement in 9 cases (69.2%), mastoiditis in four cases (30.8%), maxillary space involvement in four cases (30.8%), and palatal involvement in one case (7.7%). On statistical analysis, there was a significant association of new-onset diabetes, optic neuropathy and high C reactive protein with blindness (P-value < 0.05) in our study. However, there were no statistically significant association for the involvement of nervous system in our study. Multispecialty approach treatment was given in the liposomal amphotericin B therapy in all the patients along with thorough endo-nasal debridement done in all cases, transcutaneous retrobulbar amphotericin B in six cases (46.2%) with exenteration done in seven patients (53.9%). At 3 months of follow-up, there was substantial clinical improvement in all cases. There should be definite emphasis on high suspicion of mucor clinically for early diagnosis and aggressive management at the initial state of diagnosis for better outcomes. The need for sustained proper glycemic control during the COVID-19 era along with judicious use of steroids and public awareness of early symptoms and manifestations of mucor can curb the magnitude of such potentially opportunistic epidemics to a substantial rate. New-onset diabetes mellitus, optic neuropathy and high C reactive protein (>50 mg/L) showed statistically significant association with blindness. The longer the infection remains undetected, the greater the devastation ROCM can impose, of which blindness is an important hazard.
摘要：
犀牛眶脑毛霉菌病（ROCM）是最近后COVID-19时代大量遇到的重要传染病。在COVID-19疾病期间，防御免疫系统的改变；在不受控制的高血糖的存在下，导致了ROCM的新流行，尤其是在印度等发展中国家。这个由13名患者组成的病例系列说明了各种临床表现，实验室参数,印度北部三级医院收治的ROCM患者的影像学特征和结局.在我们的案例系列中，共研究了13例新诊断的鼻-眶-脑毛霉菌病病例。7例（53.8%）有COVID-19病史，平均25±3.6天后出现毛霉菌病，在COVID-19疾病期间使用类固醇的病例有5例(38.5%)，给予氧疗4例(30.8%)。12例（92.3％）存在糖尿病形式的共病状态，平均持续时间为16.69个月，重要发现有7例（53.85％）患有新发糖尿病；3例（23.1％）存在高血压。鼻旁窦的磁共振成像显示所有13例（100％）累及多个鼻窦，包括上颌窦和筛窦,额叶受累12例（92.3%），蝶窦受累11例(84.6%),对称参与9例(69.2%)，乳突炎4例（30.8%），上颌间隙受累4例(30.8%),上颚受累1例(7.7%)。在统计分析上,新发糖尿病有显著关联，在我们的研究中，视神经病变和高C反应蛋白与失明（P值<0.05）。然而,在我们的研究中,神经系统受累没有统计学上显著的关联.在所有患者的脂质体两性霉素B治疗中给予多专业方法治疗，并在所有病例中进行彻底的鼻内清创。经皮球后两性霉素B6例（46.2％），其中7例（53.9％）进行了切除术。随访3个月时，所有病例的临床症状均有显著改善.应明确强调临床上对粘液的高度怀疑，以进行早期诊断，并在诊断初期积极治疗以获得更好的结果。在COVID-19时代需要持续适当的血糖控制，以及明智地使用类固醇和公众对粘液的早期症状和表现的认识，可以将这种潜在的机会性流行病的规模抑制到相当大的速度。新发糖尿病,视神经病变和高C反应蛋白(>50mg/L)与失明有统计学意义.感染未被发现的时间越长，ROCM可以施加的破坏越大，其中失明是一种重要的危害。
