Introduction: Rhino Orbital Mucor Mycosis (ROMM) cases were witnessed recently in large numbers. This condition was commonly seen in patients who had recovered from COVID-19 in the previous 3 to 6 months period. The aim to present this case series is to find out ifRhino Orbital Mucor Mycosis (ROMM) in COVID-19 recovered patients are related conditions and whether the pre-existing morbid conditions worsen the clinical picture.

Methods: All cases of ROMM for Functional Endoscopic Sinus Surgery (FESS) that presented in our tertiary centre (January to June 21) were sequentially included. Patients (21 to 80 years) of both genders were 99 in number. Patients with uncontrolled systemic condition and COVID positive status were excluded till optimized and/or became COVID negative. Patients underwent optimization of presenting clinical condition from respective departments. Balanced general anaesthesia with endotracheal intubation and controlled ventilation was administered. Patients with diagnosed lower severity of ROMM were extubated on table and those with orbital and neural extension were electively ventilated; also major associated cardiovascular, neurological, renal or respiratory cases were ventilated post-operatively for gradual weaning.

Results: Patients were compared in six groups according for oxygen status, oxygen requirement, pre-existing co-morbidities, CT Severity Score, CT Brain findings and intubation difficulty. Oxygen therapy by Non Re-breathing Bag Mask (NRBM) showed P- value 0.029 (statistically significant) and that of intubation difficulty was 0.29 which are statistically not insignificant.

Conclusion: The five studied variables are independent and do not contribute to having COVID history as per this analysis.

Keywords: Statistical Analysis, Rhino Orbital Mucor Mycosis (ROMM), Convalescent COVID-19 Status

1. McElvaney, O. J. et al. “Characterization of Inflammatory Response to Severe COVID-19 Illness.”Amer J Of Respir Crit Care Med. 202, pp.812-821, 2020
2. International Rhino-sinusitis Advisory Board. Infectious Rhino-sinusitis in Adults: Classification, Etiology and Managemnt. Ear Nose Throat Journal, 76, pp. 5-22, 1997
3. Mehdiratta, L; Mishra Sandeep Kumar, Vinayagam Stalin, Nair Abhijit. “Enhanced Recovery after Surgery…still a distant speck on the horizon!” IJA, 65(2),pp. 93-96, 2021
4. Rosenfeld RM, Piccirillo JF, Chandrashekhar SS et al. “Clinical Practice Guideline: Adult Sinusitis.”Otolaryngol Head Neck Surg. 152(4), pp. 598-609, 2015
5. Braun H, Freudenschuss K, Beham A, Stammberger H. “Eosinophilic Fungal Rhino-sinusitis”- A Common Disorder in Europe? Laryngoscope,113,pp.264-269, 2003
6. Jeong W, Keighley C, wolfe R, Lee WL, Slavin MA, Kong DCM et al. “The Epidemiology and Clinical Manifestations of Mucormycosis: a Systematic review and Meta-analysis of case-reports.” Clin Microbiol Infect, 25, pp. 26-34, 2019
7. Jaffar A, al-Tawfiq, Saad Alhumaid, Abeer N. Alshukairi, mohammad –Hani Temsah, mazi Barry, Abbas Al Mutair et al.”COVID-19 and Mucormycosis Superinfection: the perfect storm.” Infection, 24(7), pp. 1-21, 2021
8. Huang C et al. “6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.” Lancet, 397, pp.220-232, 2021
9. Arnold D. T et al. “Patient outcomes after hospitalization with COVID-19 and implications for follow up: results from prospective UK cohort.” Thorax,76, pp.399-401, 2021
10. Carfi A, Bernabei R, Landi F et al. “Persistent Symptoms in patients after COVID-19.” JAMA, 324,pp-603, 2020
11. Arun Patel, Ritesh Agarwal, Shivprakash M Rudramurthy, Manoj Shevkani, Immaculata Xess, Ratna Sharma et al. “Multicenter Epidemiologic Study of Coronavirus Disease-Associated Mucormycosis, India.” Emerging Infectious Diseases, 27(9), pp. 2349-58, 2021
12. Ashraf S Ibrahim, Brad Spielberg, Dimitrios P Kontoyiannis and Thomas J Walsh. “Pathogenesis of Mucormycosis.” Clin Infect Dis. 54 (Suppl.1), pp.S16-S22, 2012
13. Dhiraj Acharya, guanQun Liu and Michaela U Gack. “Dysregulation of type 1 interferon responses in COVID-19.” Nature Reviews Immunology, 20, pp. 397-98, 2020
14. Karl V. Clemons and David A Stevens. “Comparison of Fungizone, Amphotec, Am Bisome and Abelcet for treatment of Systemic Murine Cryptococcosis.” Anti-microbial Agents and Chemotherapy, 42 (4), pp. 899-902, 1998

Dr Mrs. Vaijayanti Nitin Gadre