Management of Mucormycosis in patients associated with COVID-19

Abstract

Introduction: There are increasing case reports of rhino-orbital mucormycosis in people with coronavirus disease 2019 (COVID-19), especially from India. Diabetes mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. Material and Methods: This is a prospective study among mucormycosis patients, admitted to tertiary care teaching centre over a period of 3 months. These cases were admitted for the management of mucormycosis. They were assessed and treated by the relevant specialties at various time points, which included infection disease specialists, intensivists and otolaryngologists. Data pertaining to demographics, clinical features, comorbidities, laboratory investigations, histopathology, management and outcomes were collected. Results: In our study, maximum number of patients were history of diabetes mellitus (71.5%) while 51.5% were on medications for hypertension. Based on the CT thorax severity score, majority (60.7%) had moderate-to-severe COVID-19 pneumonia. Imaging investigations revealed that maximum patients had features of maxillary sinusitis (83.8%). All individuals were treated with liposomal amphotericin B while majority of them underwent surgical treatment. Conclusion: Preventive measures may need to focus on identification and optimal management of risk factors for Coronavirus Disease Associated Mucormycosis, including aggressive glycemic control, avoidance of steroid overuse, and possibly environmental measures.