COVID 19 & Mucormycosis- The Mystery of Intertwined Pathologies

Abstract

An anesthesiologist has been constantly pushed from the domains of being a perioperative physician to that of a COVID physician in the current COVID -19 pandemic. We have been sailing uncharted water pressured to unearth the mysteries of COVID 19 for 18 months now without any definitive treatment. Come April 2021, mucormycosis had become the talk of the town! India saw an exponential rise in cases of post covid mucormycosis. Ample theories and speculations were dug out to understand if there is a causal relationship at all. The fact is mucormycosis cases did exist in the pre-covid era as well but what led to its sudden skyrocketing numbers in covid times needed some brainstorming and hence prompted me to pen this piece of write up. Dr Poonam Ghodki, Professor of Anaesthesiology in SKNMC & GH, Pune has kindly shared some brilliant inputs from her experience of managing these challenging cases on various platforms through Anaesthesiatv. She quotes that the commonly used term black fungus is a misnomer as the black fungus is a yeast with abundant melanin on the surface. Mucormycosis is a different fungal pathology that gets its characteristic appearance due to the devitalisation of affected tissues. Although ubiquitous, human beings are resistant to its deadly invasion. Under favourable circumstances, the opportunistic fungus after angioinvasion causes ischaemia and necrosis of contagious tissue forming the hallmark blackish eschar [1]. The five main types of mucormycosis described are rhino-orbitocerebral, pulmonary, cutaneous, gastrointestinal and disseminated, of which rhino-orbitocerebral has been observed to be the commonest. In the rhino-orbitocerebral variant, the fungus invades the lamina papyracea of ethmoidal sinuses and gains access to orbit leading to proptosis and blindness. It could gain entry through the cribriform plate to the brain and cause sagittal sinus thrombosis and stroke. Gaining further clarity on managing Covid 19 cases recovery increased man