ABSTRACT
Introduction: Mucormycosis is associated with high mortality (45-90%) in average-income countries including India. Prevention of mucormycosis associated with coronavirus disease 2019 (COVID-19) or in patients recovering from COVID-19 needs a further understanding on epidemiology and underlying risk factors. Methodology: A hospital-based observational cross-sectional study was performed in a dermatology ward and neurosurgery ward, King George Hospital, Visakhapatnam (dedicated wards for mucormycosis), during May-June 2021 (60 days). After obtaining permission from Institutional Ethics Committee, the convenience sampling method was used and 115 cases admitted for mucormycosis who are post-COVID-19 patients were included in the study. Complete case history including the demographic data and signs and symptoms including the course of hospitalisation for COVID-19 was collected through a semi-structured questionnaire, and detailed clinical examination was conducted in relation with mucormycosis. Data collected were entered in MS excel 2010, and the analysis was performed using SPSS Version 21 for testing the level of significance with P < 0.05. Results: The majority of the patients belong to the 51-60 years (31.3%) age group, and 76.5% of them were females. Diabetes mellitus (76.5%) was the most common co-morbidity. Inhalational oxygen was given to 68 (59.1%) of patients. Pain in the eyes and nose was the most common complaint in patients with mucormycosis. Oxygen therapy during hospital admission and the presence of co-morbidities were significantly associated with findings of broad aseptate fungal hyphae on KOH mount. Conclusions: Prevention of COVID-19-associated mucormycosis needs to focus on aiming for appropriate oxygen therapy and better glycaemic control in COVID-19 patients and monitoring the use of systemic corticosteroids in treating severe cases.
ABSTRACT
Context: During the challenging second wave of the COVID-19 pandemic, we encountered a most dreadful fungal infection in the form of COVID-associated mucormycosis (CAM), with a varied pattern of presentation from previous experience. Patients presented with simple fungal sinusitis or more complicated brain abscesses, and newer manifestations such as skull osteomyelitis. We report our findings and innovative treatment strategies used to manage this morbid condition. Objectives: To study the various presentations and surgical strategies in treating post-COVID rhino-orbito-cerebral mucormycosis (ROCM). Settings and Design: Observational cross-sectional study. Methods and Materials: From May to October 2021, 270 patients with CAM were admitted to Andhra Medical College Department of Neurosurgery, King George Hospital, Visakhapatnam, India. A cohort of 61 cases with intracranial involvement was studied in detail. The varied presentations and different or innovative treatment modalities were analyzed. Results: The death rate was 30/270 in the whole cohort, and three deaths (4.9%) occurred in 61 cases with cranial involvement. Thirty-three (54.1%) of the 61 cases were treated surgically: 17 patients required bone excision (for focal osteomyelitis) and 16 cases required abscess drainage/excision. Conclusions: Post-COVID mucormycosis (especially with intracranial involvement) is a highly challenging entity. A multidisciplinary approach with early and aggressive anti-fungal medication combined with timely surgical interventions offers some hope of overcoming this complex infection in CAM patients. We identified some novel techniques during regular follow-up that have proven helpful in combatting this devastating condition.