A study on clinico-radiological profile, risk factors, and management of mucormycosis during COVID pandemic in Rewa, (M.P.)

Abstract

Background: Second wave of coronavirus disease 2019 (Covid-19) pandemic has been particularly devastating in India. COVID-19 and mucormycosis (also known as black fungus) are causing comorbid conditions to worsen the extent of infection and mortality rates especially in India. Mucormycosis can involve nose, sinuses, orbit, central nervous system, lung (pulmonary), gastrointestinal tract any many other organs, but rhino orbital cerebral mucormycosis is the most common variety seen. Rapidity of dissemination of mucormycosis is an extraordinary phenomenon and a delay in the diagnosis could be fatal.

Aims and Objectives: The objective of this study is to document the clinical features, radiological extent, risk factors, management,
and outcome of mucormycosis.

Materials and Methods: The study was retrospective observational study. Eighty-two mucormycosis patients admitted in SGMH Rewa were selected as study subjects. Data regarding clinical features, radiological extent, associated risk factors, comorbidities, management during hospital stay, and outcome of mucormycosis patients were collected on excel sheet and analyzed using appropriate statistical tests.

Results: In our study, majority of the patients were unvaccinated (88%). Most common presenting complaint was nasal congestion with or without discharge in 78% patients followed by Facial swelling, visual disturbances, facial weakness, dental pain, etc. On CT or magnetic resonance imaging examination, all cases of mucormycosis had maxillary sinus (100%) involvement, followed by ethmoid (82%) and sphenoid (78%) sinuses. Diabetes mellitus was most common comorbidity seen in 52% cases. About 83% cases had history of receiving high dose steroid intravenously during management of COVID illness. Among study cases 72% patients have taken oxygen supplementation for more than 72 h, for COVID-19 pneumonia before hospitalization for mucormycosis. Therapy of Liposomal Amphotericin B and Oral Triazole (predominantly oral Posaconazole) was the most common medical treatment offered to all patients with COVID associated mucorpatient. Functional endoscopic sinus surgery was done on 93% cases followed by Modified Denker’s procedure was done in 12% cases.

Conclusion: In our study, mucormycosis appears to be associated with COVID-19, diabetes, and use of corticosteroids. Full vaccination with COVID-19 vaccines, judicious use of corticosteroids in patients with COVID-19 and strict control of blood glucose level along with timely and proper management is highly recommended to reduce the incidence of fatal mucormycosis.