Abstract

Rhino-Orbito-Cerebral Mucormycosis and its Imaging Spectrum a Prospective Observational and Analytical Study in the Setting of Covid 19 Pandemic in a Tertiary Care Centre, AP, India

Background: Rhino-Orbital-Cerebral Mucormycosis (ROCM) is a potentially fatal fungal infection that commonly affects diabetic and other immunocompromised patients. Necrotizing and Angioinvasive features of this class of pathogenic fungi facilitate the spread from sinuses into orbit and the brain with devastating consequences. Early diagnosis and timely intervention are key to successful treatment. Aims and Objectives: This article aims to interpret the findings on CT and MRI in ROCM. The primary objective of this study is to enumerate the imaging findings of all patients presented with Rhino orbital cerebral mucormycosis at various stages and to describe the management algorithm. The secondary objective is to follow up on aggressive cases after successful therapy. Materials and Methods: This prospective observational descriptive and analytical study was conducted in the Department of Radiodiagnosis, Andhra Medical College, King George Hospital, Visakhapatnam, India from April 2021 to august 2021 for 5 months. Reviewed 100 patients of the adult age group with strong clinical complaints suggestive of ROCM. Few patients are further followed up for another 6-month to 1-year period wherever necessary. Variables: Age, sex, diabetes, steroid use, O₂ supplementation. Results: We present 100 cases of ROCM to emphasize the effectiveness of Magnetic Resonance Imaging (MRI) in the diagnosis of this potentially fatal form of mucormycosis. A Favorable outcome was achieved with surgical debridement and prolonged Amphotericin therapy. CT and MR imaging of 100 patients showed predominantly pan-sinus involvement (67%). Extension to the orbit and face (66%) preceded involvement of the deep skull base (62%) and brain (40%). Ontrast-Enhanced Computed Tomography (CECT) showed minimally enhancing hypodense soft tissue thickening as the predominant finding in involved areas, while MRI showed T2 hypointense with post-obstructive T2 hyperintense changes/ soft tissue thickening and heterogeneous post-contrast enhancement as the main finding. Bone erosion was seen less often (40%), with the rest of the patients (60%) showing extra sinus extension across grossly intact appearing bones on imaging. Conclusion: CT and MRI show a spectrum of findings in Rhino orbital cerebral mucormycosis. Imaging plays a major role in assessing the extent of involvement and complications. DWI may add specificity to the diagnosis by showing restricted diffusion in the path of fungal invasion. Thus Magnetic resonance imaging is the effective imaging modality for the diagnosis of ROCM, for the staging of the disease, for patient management, and follow-up. Recommendations: Aiming for better glycemic control in those with diabetes, appropriate use of systemic corticosteroids, and prevention of unnecessary use of antibiotics, antifungals, and other immunomodulators. Infection Prevention and Control (IPC) program measures at the facility level are essential to prevent the environmental spread of this pathogen.

• Full-Text
• PDF