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

Research Article Volume 5 Issue 3

COVID-19 Associated Rhino-Orbital Mucormycosis During the Pandemic: Our Experience on Diagnostic Challenges to Management

Pooja S Nagare1, Ravi Sasank Sai2* and Ishita Wadhwa2

1Associate Professor, Department of Otorhinolaryngology, Therna Medical College, India
2Junior Resident, Department of Otorhinolaryngology, Dr.B.V.P Pravara Institute of Medical Sciences, Ahmednagar, India

*Corresponding Author: Ravi Sasank Sai, Junior Resident, Department of Otorhinolaryngology, Dr.B.V.P Pravara Institute of Medical Sciences, Ahmednagar, India.

Received: February 06, 2023; Published: February 27, 2023

Abstract

Mucormycosis, also known as black fungus, is a rare but serious fungal infection that has been increasingly reported in patients with COVID-19. This infection typically affects the sinuses, but can also spread to the brain, lungs, and other parts of the body.

Risk factors for mucormycosis include uncontrolled diabetes, immunosuppression, and prolonged use of steroids. Patients with COVID-19 who have been hospitalized and on mechanical ventilation, as well as those who have received high doses of steroids, are particularly vulnerable to this infection.

Symptoms of mucormycosis include severe headache, facial pain or swelling, black discharge from the nose, and difficulty breathing. If left untreated, the infection can lead to blindness, brain damage, and even death.

Early diagnosis and prompt treatment are crucial for managing mucormycosis in patients with COVID-19. Treatment typically involves a combination of antifungal medications and surgical debridement of infected tissue.

It is important for healthcare providers to be aware of the potential for mucormycosis in patients with COVID-19, particularly those who have risk factors or are experiencing severe symptoms. Maintaining good glycemic control and avoiding unnecessary use of steroids in COVID-19 patients may also help to reduce the risk of mucormycosis.

Aim and Objective: 1. To provide a comprehensive overview of the clinical presentation, symptomatology, pathological, and radiological findings in cases of mucormycosis. 2. To examine the role of various risk factors in the development and progression of Post-COVID-19 mucormycosis and to use these findings to design a customized treatment strategy.

Methods: A prospective longitudinal study was conducted at our tertiary healthcare center in Maharashtra. Participants were selected based on the presence of clinical symptoms of mucormycosis and COVID-19 recovery. A comprehensive medical examination was performed, including otorhinolaryngologic (DNE, KOH, Fungal Culture), medical, and ophthalmological evaluations, as well as laboratory tests, biopsy, and imaging studies. The treatment strategy included administration of IV antifungals (Liposomal-Amphotericin B) and surgical procedures such as Modified Denker's approach, open maxillectomy, and orbital exenteration if needed. The patients were followed up for six months to monitor for recurrence.

Results: An initial diagnosis was made based on KOH mount and CT and MRI studies followed by fungal culture. All the patients were surgically treated. Out of 25 patients 12 patients underwent Endoscopic sinus surgery with modified Denker's approach, 4 patients underwent Total Maxillectomy with external facial degloving approach. One patient underwent surgical exenteration of the involved eye. All the patients were administered with Liposomal-Amphotericin-B 4 mg/Kg/body weight for a period of 14-21 days Patients were discharged after 21 days with Posaconazole and followed up after 3-weeks, 3-months and 6-months post-operatively and routine diagnostic nasal endoscopy is performed during all OPD visits and all the patients had significant improvement.

Conclusion: In India, particularly among the diabetic patients with steroid therapies for COVID-19 recovery during the second wave there was an exponential increase in invasive fungal diseases like Mucormycosis. Early diagnosis and prompt initiation of appropriate antifungal therapy is crucial in the management of post-COVID mucormycosis.

 

Keywords: Mucormycosis; Modified Denker’s Approach; Rhino-Orbital-Cerebral Mucormycosis; Invasive Fungal Sinusitis; Post-Covid-19 Mucormycosis

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Citation

Citation: , Ravi Sasank Sai., et al. “COVID-19 Associated Rhino-Orbital Mucormycosis During the Pandemic: Our Experience on Diagnostic Challenges to Management".Acta Scientific Otolaryngology 5.3 (2023): 55-66.

Copyright

Copyright: © 2022 , Ravi Sasank Sai., et al. 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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