Acta Scientific Otolaryngology (ASOL) (ISSN: 2582-5550)

Case Series Volume 3 Issue 9

A Case Series of Rhino-Orbital Mucormycosis in COVID-19 Patients

K S Dinesh1* and R Vanitha2

1Senior Resident, Department of Otorhinolaryngology, Government Medical College Krishnagiri, Tamilnadu, India
2Assistant Professor, Department of Ophthalmology, Government Medical College Krishnagiri, Tamilnadu, India

*Corresponding Author: K S Dinesh, Senior Resident, Department of Otorhinolaryngology, Government Medical College Krishnagiri, Tamilnadu, India.

Received: August 07, 2021; Published: August 30, 2021

Abstract

  Mucormycosis is caused by filamentous fungi of Mucor, Rhizopus, Absidia, Apophysomyces, Saksenae and Cunninghumella of the Mucorales order. Mucormycosis was first described by Paultauf A in 1885. Neutrophils play a key role in the host defence against mucormycosis. Ketoacidosis, hyperglycemia and hypoxia are excellent growth conditions for mucormycosis. Impairment of phagocytosis due to immunosuppression causes germination of spores into hyphae resulting in angio-invasion. Recently, the surge in mucormycosis is linked to the second wave of COVID-19 infection mostly due to uncontrolled diabetes in patients managed with steroids. India has emerged as being the mucormycosis capital in recent times. In this study report, we present the clinical findings and therapeutic outcomes of rhino-orbital mucormycosis in 3 male patients, age range between 45 - 75 years old all had diabetes mellitus and underwent treatment for COVID-19 pneumonia. All patients developed proptosis, sinusitis and decreased visual acuity with no light perception in the two patients with severe orbital involvement. Histopathological examination of tissue biopsy revealed typical Mucor hyphae. Systemic liposomal amphotericin B was initiated in all patients. The patients with limited ocular involvement received amphotericin B both intravenously and by local irrigation; one patient had complete recovery. All 3 patients underwent functional endoscopic sinus surgery (FESS) with orbital decompression and one patient needed orbital exenteration. One patient died after declining systemic treatment postoperatively. Early diagnosis and intervention with antifungal medication and surgical clearance of the disease may help avoid mutilating surgery like exenteration. Basic safety precautions like proper use of mask, single use of oxygen tube, using distilled water, hand washing and social distancing will go hand in hand to prevent the fulminant nature of the disease. Long term monitoring of patients is essential for favorable outcome.

Keywords: Mucormycosis; COVID-19; Diabetes Mellitus; FESS; TRAMB

References

  1. Kubin Christine J., et al. “Characterization of Bacterial and Fungal Infections in Hospitalized Patients With Coronavirus Disease 2019 and Factors Associated With Health Care-Associated Infections”. Open Forum Infectious Diseases 6 (2021): ofab201.
  2. Eucker J., et al. “Mucormycoses”. Mycoses 7-8 (2001): 253-260.
  3. White P Lewis., et al. “A national strategy to diagnose COVID-19 associated invasive fungal disease in the ICU”. Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America (2020): ciaa1298.
  4. Gangneux, J-P., et al. “Invasive fungal diseases during COVID-19: We should be prepared”. Journal de Mycologie Medicale2 (2020): 100971.
  5. Baldin Clara and Ashraf S Ibrahim. “Molecular mechanisms of mucormycosis-The bitter and the sweet”. PLoS Pathogens 8 (2017): e1006408.

Citation

Citation: K S Dinesh and R Vanitha. “A Case Series of Rhino-Orbital Mucormycosis in COVID-19 Patients".Acta Scientific Otolaryngology 3.9 (2020): 67-72.

Copyright

Copyright: © 2020 K S Dinesh and R Vanitha. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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Impact Factor0.871

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