IDF21-0421 High blood sugar as a risk factor for post COVID-19 rhino-orbital-cerebral mucormycosis

Abstract

Background: Mucormycosis is an invasive fungal infection which is known to cause involvement of paranasal sinuses, orbits and brain. It occurs mainly in immunocompromised patients. The recent COVID-19 pandemic has led to a sudden upsurge of mucormycosis in COVID recovered patients in India leading to high mortality despite of antifungal therapy and surgical debridement. We studied the association of COVID-19 with diabetes with the use of steroids in the occurrence of this life-threatening infection. Aim: To study the epidemiological profile of post COVID-19 mucormycosis patients presenting to a tertiary care teaching hospital. Method: All patients more than 20 years of age, who got admitted with various complaints in the months of June and July, 2021 (with preceding history of COVID-19 within last 3 months) and diagnosed as one or the other forms of mucormycosis were included in the study. Risk factors for all were assessed. Results: Total 37 patients got admitted in mucor unit in two months (21 males, 16 females). Commonest age of presentation was between 51 to 60 years. After biopsy and imaging, 18 (48.65%) patients were diagnosed as rhino-orbital mucormycosis, 11 (29.73%) as rhino-orbital-cerebral mucormycosis and 8 (21.62%) as rhino-cerebral mucormycosis. Out of the 37 patients, 31 were known diabetics while rest 6 were recently diagnosed to present with high sugar. All these patients had a history of steroid administration during their COVID infection with poor blood sugar management and 17 patients also had history of taking oxygen therapy for their respiratory symptoms during the COVID illness. Discussion: There has been a steep rise in the cases of various types of mucormycosis after COVID-19 infection post-second wave in India. Almost all such patients have a common risk factor of uncontrolled blood sugar along with steroid use. A careful approach of strict sugar control with judicious use of steroids can minimise a lot of cases of this serious life-threatening infection.