COVID-19 associated rhino orbital mucormycosis : Single center experience of 21 cases

A S R De Alwis,K D R A Kirihena,W P L Weerakkody

doi:10.4038/cjo.v11i1.5332

A S R De Alwis, K D R A Kirihena + Show 1 more

Open Access

https://doi.org/10.4038/cjo.v11i1.5332

Copy DOI

Abstract

Intensifying the burden of the second wave of COVID-19 in Sri Lanka, invasive mucormycosis started emerging in numbers among COVID-19 recovered patients. It was commonly found among immunocompromised patients. Prompt initiation of antifungals and aggressive surgical debridement contributes immensely for the overall prognosis.

Highlights

A considerable increase in the number of cases of mucormycosis is observed during the second wave of COVID 19 in Sri Lanka leading to high morbidity and mortality
Major comorbidities were Diabetes mellitus (100%), chronic kidney disease (55%) while the minority had hypertension, dyslipidemia, post Kidney Transplant, ischemic heart disease and bronchial asthma
Even though the majority (61.9%) got commenced on amphotericin within 2-3 days of clinical suspicion, the median lag period is 7.1 days.The serum creatinine was raised in all the subjects from the baseline level and 23.8% developed acute kidney injury

Summary

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a range of bacterial and fungal co-infections. A considerable increase in the number of cases of mucormycosis is observed during the second wave of COVID 19 in Sri Lanka leading to high morbidity and mortality This air bone infection, mainly affecting the upper or lower airways, leads to sinusitis with or without orbital and cerebral involvement or pulmonary infection. Orbital decompression was carried out in 71.42% and optic nerve decompression in Two underwent debridement of the facial muscles due to extensive cutaneous involvement. Majority of the patients presented with orbital symptoms such as eye pain, periorbital swelling, proptosis or loss of vision to an ophthalmologist, or with headache and facial pain and numbness to a neurologist. Despite maximum surgical debridement and antifungal therapy 60 % mortality rate was observed in patients with cerebral involvement[9]. Even Though Posaconazole is recognized as a second line agent with an effect on survival in the refractory cases, the unavailability warrants its use in our patients[10]

Conclusion

Findings

Sri Lanka News