Rahul S Gosavi¹, Aishwarya M Tamne²*, Vishal K Magdum³, Shishir S Gosavi⁴, Shalvi N Hajare⁵ and Prateek P Shahane⁶

¹Assistant Professor Department of ENT, Sanjeevan Medical Foundation ENT PG Training Institute, Miraj, Maharashtra, India
^2,5,6Third Year Junior Resident Department of ENT, Sanjeevan Medical Foundation ENT PG Training Institute, Miraj, Maharashtra, India
³Associate Professor Department of ENT, Sanjeevan Medical Foundation ENT PG Training Institute, Miraj, Maharashtra, India
⁴Director, HOD, Department of ENT, Sanjeevan Medical Foundation ENT PG Training Institute, Miraj, Maharashtra, India

*Corresponding Author: Aishwarya M Tamne, Third Year Junior Resident Department of ENT, Sanjeevan Medical Foundation ENT PG Training Institute, Miraj, Maharashtra, India.

Received: March 15, 2023; Published: March 31, 2023

Abstract

Mucormycosis was first reported as cause of human disease in 1885. Its an acute necrotizing fungal infection with fulminant course due to angioinvasion, being potentially deadly fungal infection with a mortality rate of 50%. It has been challenge for us to address in patients who had covid-19 infection. The rise in number in developing countries has been evident among those with uncontrolled diabetes and renal failure. Use of steroids early in the disease, continuous use of high flow oxygen, dry air in ICU, use of nasal prongs can cause dryness of nose and prolonged bedridden state thereby reducing nasal mucosal immunity are some of the attributable causes. This is a retrospective observational study of 71 post covid patients reported to our department with their confirmed histopathological reports of mucormycosis. About 68% of patients presented with “only sinus” type of mucormycosis. 20% presented with “rhino-orbital” and 12% with “rhino-orbital-cerebral” presentation. Palatal erosion was more common in sinus type. Involved facial tissues, including skin and muscle, any implicated skin on the nose, the maxillary and ethmoid sinuses, necrotic tissue in the infratemporal fossa, and orbital exenteration are all removed during surgery. Endoscopic debridement of disease with Intravenous Amphotericin B injection was the basis of treatment. The study indicates different management approach medically and surgically with great flexibility was the need of hour. Rapid Diagnostics, early antifungal therapy and prompt surgical intervention are essential.

Keywords: Black Fungus; COVID-19; Uncontrolled Diabetes Mellitus; Mucormycosis; Amphotericin B; Posaconazole

References

1. Narayanan Shivakumar., et al. “Coronavirus Disease 2019-Associated Mucormycosis: Risk Factors and Mechanisms of Disease”. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America7 (2022): 1279-1283.
2. Muthu Valliappan., et al. “Epidemiology and Pathophysiology of COVID-19-Associated Mucormycosis: India Versus the Rest of the World”. Mycopathologia6 (2021): 739-754.
3. Sivapathasundharam B. “Shafer’s Textbook of Oral Pathology”. 8^th New Delhi, India: Elsevier (2012): 435‑436.
4. Roden, Maureen M., et al. “Epidemiology and outcome of zygomycosis: a review of 929 reported cases”. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America5 (2005): 634-653.
5. Rodriguez-Morales, Alfonso J., et al. “COVID-19 associated mucormycosis: the urgent need to reconsider the indiscriminate use of immunosuppressive drugs”. Therapeutic Advances in Infectious Disease 8 (2021): 20499361211027065.
6. Baldin Clara and Ashraf S Ibrahim. “Molecular mechanisms of mucormycosis-The bitter and the sweet”. PLoS Pathogens8 (2017): e1006408.
7. Kamat Mamata., et al. “COVID-19-associated mucormycosis of head-and-neck region: A systematic review”. Journal of Clinical and Translational Research1 (2022): 31-42.
8. Marx RE and Stern D. “Inflammatory, Reactive and Infectious Diseases in Oral and Maxillofacial Pathology”. Carol Stream III, USA. Quintessence Publishing (2003): 104‑106.
9. Kajs-Wyllie M. “Hyperbaric oxygen therapy for rhinocerebral fungal infection”. The Journal of neuroscience nursing: journal of the American Association of Neuroscience Nurses3 (1995): 174-181.
10. Lador Nilly., et al. “A trifungal infection of the mandible: case report and literature review”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics4 (2006): 451-456.
11. Artis WM., et al. “A mechanism of susceptibility to mucormycosis in diabetic ketoacidosis: transferrin and iron availability”. Diabetes12 (1982): 1109-1114.
12. Petrikkos George and Constantinos Tsioutis. “Recent Advances in the Pathogenesis of Mucormycoses”. Clinical Therapeutics6 (2018): 894-902.
13. Alekseyev, Kirill., et al. “Rhinocerebral Mucormycosis and COVID-19 Pneumonia”. Journal of Medical Cases3 (2021): 85-89.
14. Apicella Matteo., et al. “COVID-19 in people with diabetes: understanding the reasons for worse outcomes”. The Lancet. Diabetes and Endocrinology9 (2020): 782-792.
15. Lin Xiling., et al. “Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025”. Scientific Reports1 (2020): 14790.
16. Montefusco Laura., et al. “Acute and long-term disruption of glycometabolic control after SARS-CoV-2 infection”. Nature Metabolism6 (2021): 774-785.
17. Castrejón-Pérez Ana Daniela., et al. “Cutaneous mucormycosis”. Anais Brasileiros de Dermatologia3 (2017): 304-311.
18. Spellberg Brad., et al. “Novel perspectives on mucormycosis: pathophysiology, presentation, and management”. Clinical Microbiology Reviews3 (2005): 556-569.
19. Kim J., et al. “A fatal outcome from rhinocerebral mucormycosis after dental extractions: a case report”. Journal of Oral and Maxillofacial Surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons6 (2001): 693-697.
20. Doni Bharati R., et al. “Sequence of oral manifestations in rhino-maxillary mucormycosis”. Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research2 (2011): 331-335.
21. Burkets Textbook of Oral Medicine Diagnosis and Treatment 10^th Elsevier; Canada (2003): 79.
22. Roden Maureen M., et al. “Epidemiology and outcome of zygomycosis: a review of 929 reported cases”. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America5 (2005): 634-653.
23. Mehta Salil and Abha Pandey. “Rhino-Orbital Mucormycosis Associated With COVID-19”. Cureus9 (2020): e10726.
24. Sanghvi D and H Kale. “Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the "black fungus". Clinical Radiology11 (2021): 812-819.
25. Skiada A., et al. “Challenges in the diagnosis and treatment of mucormycosis”. Medical Mycology1 (2018): 93-101.
26. Peixoto Driele., et al. “Isavuconazole treatment of a patient with disseminated mucormycosis”. Journal of Clinical Microbiology3 (2014): 1016-1019.
27. Ervens J., et al. “Successful isavuconazole salvage therapy in a patient with invasive mucormycosis”. Infection 42,2 (2014): 429-432.
28. Graves Bianca., et al. “Isavuconazole as salvage therapy for mucormycosis”. Medical Mycology Case Reports 11 (2016): 36-39.
29. Mekonnen Zesemayat K., et al. “Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID-19-Associated Acute Respiratory Distress Syndrome”. Ophthalmic Plastic and Reconstructive Surgery2 (2021): e40-e80.
30. Dallalzadeh Liane O., et al. “Secondary infection with rhino-orbital cerebral mucormycosis associated with COVID-19”. Orbit (Amsterdam, Netherlands)5 (2022): 616-619.
31. Cornely, Oliver A., et al. “Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium”. The Lancet. Infectious Diseases12 (2019): e405-e421.
32. Alobid I., et al. “Treatment of rhinocerebral mucormycosis by combination of endoscopic sinus debridement and amphotericin B”. American Journal of Rhinology5 (2001): 327-331.
33. Rapidis AD. “Orbitomaxillary mucormycosis (zygomycosis) and the surgical approach to treatment: perspectives from a maxillofacial surgeon”. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases5 (2009): 98-102.
34. Ferguson BJ. “Mucormycosis of the nose and paranasal sinuses”. Otolaryngologic clinics of North America2 (2000): 349-365.
35. Kyrmizakis Dionysios E., et al. “Palate ulcer due to mucormycosis”. The Journal of Laryngology and Otology2 (2002): 146-147.
36. Hosseini Seid Mousa Sadr and Peyman Borghei. “Rhinocerebral mucormycosis: pathways of spread”. European Archives of Oto-Rhino-Laryngology: Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery11 (2005): 932-938.
37. Palacios Julio Juarez., et al. “Reconstruction of Head and Neck Mucormycosis: A Literature Review and Own Experience in Immediate Reconstruction”. Journal of Reconstructive Microsurgery Open04 (2019): e65-e72.
38. Abu El-Naaj Imad., et al. “The surgical management of rhinocerebral mucormycosis”. Journal of Cranio-Maxillo-Facial Surgery: Official Publication of the European Association for Cranio-Maxillo-Facial Surgery4 (2013): 291-295.

Citation

Citation: Rahul S Gosavi., et al. “Mucormycosis in Covid; A Diagnostic and Therapeutic Challenge".Acta Scientific Otolaryngology 5.4 (2023): 44-55.

Copyright

Copyright: © 2023 Rahul S Gosavi., 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.