COVID-19 Associated Rhino-Orbital-Cerebral Mucormycosis - An Institutional Series

Nishant Rana

doi:10.31579/2692-9562/041

Abstract

Invasive fungal infection or mucormycosis is almost always confined to the patients with altered host defenses such as in transplant recipients, diabetics or patients with malignancies. Hypergycemia or uncontrolled diabetes, particularly diabetes acidosis is considered as the strongest and very well known risk factor for mucormycosis. It has spread like fire amongst the active COVID-19 and post COVID-19 diabetic patients. Many studies across the world have established the definitive severity of SARS-CoV-2 infection amongst diabetic patients.

Highlights

India is recognized as the diabetes and mucormycosis ‘capital’ of the world [1]
Coronavirus disease 2019 (COVID-19) second wave in India has presented in a catastrophic way as compared to the first wave and startled the medical fraternity
COVID-19 infection has led to worst consequences in the patients especially with uncontrolled diabetes, immunocompromised, immunosuppressed and those who were managed with long periods or high doses of systemic corticosteroid therapy [3]

Summary

Introduction

India is recognized as the diabetes and mucormycosis ‘capital’ of the world [1]. Diabetes is the fastest growing non-communicable disease in India. Rest 37 out of 43 rhino-orbital mucormycosis patients showed improvement in ptosis, propotosis, congestion and vision with anti-fungal therapy Those 2 patients whose family did not give consent were having cerebral involvement and died after few days of ICU care. A different pattern of presentation has been encountered amongst the patients who presented during later phase of this post-COVID-19 mucormycosis These patients had locally restricted disease to unilateral sinuses and maxilla (palate) [Figure 14 to 17]. 7 patients (out of 27 rhinomucormycosis patients) presented with floor of maxilla and sinus involvement with blackish discoloration within nose or palate, loosening of teeth and abscess in the gingival tissue They had history of COVID19 infection of more than 3 months, all were diabetics and had history of corticosteroid treatment. Mean age (in years)[standard deviation] Male:Female Patients with active COVID-19 infection

Rhinomucormycosis With palatal and dental involvement

Conclusion

Findings

Conflict of interest