Mucor Mycosis Maiming COVID-19 Recovered Patients in India?

Abstract

The year 2021 will go in the history of Indian Ophthalmology as the year of fungal infections among Covid 19 recovered patients as a leading cause of vision or eye loss and facial disfigurement due to post -Covid 19 Fungi- mucor mycosis infections. First published article of mucor mycosis (MM) leading to loss of eye and disfigurement of the face was traced to 1970 in USA. First media report in India came from Ganga Ram Hospital in Delhi, that treated 12 cases of COVID triggered deadly Mucor mycosis fungus cases. Eye & ENT surgeon had to do resection and fungus debridement in 10 cases in one fortnight in December 2020 of which half lost one eye permanently. Mucor mycosis (MM) is an aggressive opportunistic fungal infection, affecting any parts of the body, but rhino-cerebral-orbital type is the commonest leading to blindness and facial disfiguration. Doctors at Bowring and Lady Curzon Medical College Hospital, Bengaluru which has treated more than 140 patients with mucor mycosis, after cell culture tests have confirmed in 95% of the cases the presence of Mucor mycosis, and remaining MM, Aspergillus niger and Candida albicans. Since Mid-April 2021 India has reported about 31,000 MM cases as on 12 June 2021. It is fared that nearly 50% of them have lost at least one eye and some both. Five states of Maharashtra, Gujarat, Rajasthan, Karnataka, and Andhra Pradesh contribute nearly two thirds of the cases and deaths. The latest report of 1700 hrs on 13 June 2021, from Maharashtra puts the total cases at 7395, deaths at 720, 2212 cured and 4463 still under treatment. This state has seen threefold increase in the MM cases reported in just 3 weeks’ time between 25th May and 13 June 2021. Among those recovered one has witnessed lot of facial disfigurement, due to the damages to eyes, nose, jaw bones and oral cavity. Some of them who can afford go in for multiple plastic surgeries costing anywhere between INR 2.5 to 15 million. Traditionally mucor mycosis treatment must start without waiting for laboratory confirmation, but recently a new diagnostic tool with the capability for confirming infection in 24-48 hours is being promoted and is likely to help minimise the damage at least among those who can afford. In this review I have collated and presenting epidemiology, Pathophysiology, available diagnostic support, and treatment of MM infections affecting eyes, nose and disfigurement of face and possible reconstructive surgeries from various sources.