Mucormycosis among Coronavirus Disease 2019 Patients: An Institutional Experience
Ankit Kaushik, Anamika Jaiswal, Suman Kumari Pandey, Hari Shankar PandeyAbstract
Background:
The mucormycosis is a rare angioinvasive group of opportunistic fungal infection, occurs among diabetic and immunocompromised persons. In coronavirus disease 2019 (COVID-19) pandemic, a large number of moderate-to-severe patients with comorbidities such as diabetes were managed by steroids. The mucormycosis emerged as epidemic across India.
Aim:
This study attempts to present the clinical presentation of mucormycosis among COVID-19 patients with emphasis on the presence of predisposing factors, clinical manifestation, type of mucormycosis, and need for early management.
Materials and Methods:
The data regarding patients presenting with mucormycosis were collected; the patients with current or recent history of mucormycosis within previous 3 months were selected out. The KOH preparation confirmed cases of mucormycosis are selected in this study. The clinicoepidemiological profile of patients including age, gender, significant past history, drug history, and comorbidity was collected. The clinical features of patients were noted. The relevant examination findings were noted; along with radiological finding including computed tomography findings were noted for sinus, orbital, and cerebral involvement.
Results:
This study involves 12 cases of mucormycosis with 8 being males and rest 4 were female; the male-to-female ratio was 2:1. The mean age was 53.67 years, 7 were diabetic, 5 presented with mucormycosis and COVID-19, and 6 had recent history of COVID-19. The steroid administration history was present in 10 patients. The most common type of mucormycosis was rhino-orbital mucormycosis with 8 cases, followed by rhinomucormycosis type with 2 cases, rhino-orbital-cerebral type with 1 case, and rhinopalatal mucormycosis with 1 case. The most common nasal or sinus symptom was red or black nasal discharge and hemifacial pain. The most common orbital symptom was loss of vision and red eye. The most common symptom of oral cavity involvement was ulcer over the hard palate and blackening of palate. On rhinoscopy, 4 had black eschar present. The most common sinuses involved were maxillary and ethmoidal sinus. Out of 12 cases, only two patients were managed medically on IV amphotericin B while 10 underwent surgical management.
Conclusion:
The early identification of mucormycosis identification of high-risk persons and features of early sinus involvement was noted. The early identification and treatment can lead to reduction in morbidity and mortality due to mucormycosis.