Abstract
Mucormycosis is an invasive fungal infection occurring in patients with or without preexisting medical illnesses. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal coinfections among some COVID-19 patients with preexisting comorbid illnesses such as diabetes and hypertension, with mucormycosis being one of them. The management of this dreaded fungal infection demands early and prompt surgical intervention to thoroughly remove the infected tissue and necrotic material to reduce the tissue burden of this invasive organism. This should be accompanied by expeditious initiation of amphotericin B along with supportive therapy. Here we present five cases of rhino-orbital mucormycosis in patients with COVID-19, all of whom presented with orbital and facial swelling (three had symptoms of impending blindness) under the backdrop of COVID-19 symptoms in the form of intermittent fever and slight dyspnea. Our treatment strategy comprised an expeditious use of early surgical intervention and amphotericin B along with the control of cytokine storm and hyperglycemia. This treatment strategy eventually resulted in an improved clinical outcome.
Highlights
The repeated upsurge in the cases of severe acute respiratory syndrome coronavirus-2 infection, or coronavirus disease 2019 (COVID-19), is still causing havoc worldwide [1]
A few studies have inferred that morbidity and mortality of rhino-orbital mucormycosis are determined by the time gap between the initiation of surgical debridement and amphotericin B coupled with the delay in controlling the underlying risk factors
We report five cases of rhino-orbital mucormycosis associated with COVID-19, where an early clinical diagnosis followed by early surgical intervention and antifungal medications successfully reduced the mortality and morbidity and resulted in an improved clinical outcome
Summary
The repeated upsurge in the cases of severe acute respiratory syndrome coronavirus-2 infection, or coronavirus disease 2019 (COVID-19), is still causing havoc worldwide [1]. We report five cases of rhino-orbital mucormycosis associated with COVID-19, where an early clinical diagnosis followed by early surgical intervention and antifungal medications successfully reduced the mortality and morbidity and resulted in an improved clinical outcome. A single-time, cross-sectional study was undertaken which included the patients of COVID-19 and rhino-orbital mucormycosis coinfection admitted during May 2021 Demographic details of these patients along with their previous known comorbidities and clinical presentation at admission were noted. How to cite this article Barman Roy D, Gupta V, Biswas A, et al (August 14, 2021) Early Surgical Intervention Followed by Antifungals in Rhino-Orbital Mucormycosis in Patients With COVID-19 Favors Clinical Outcome: A Case Series. Once the induction phase of liposomal amphotericin B was over, syrup posaconazole was started and continued
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