Post surgery mucor recurrence in COVID-19 associated mucormycosis patients of a tertiary care centre
Keywords:COVID associated mucormycosis, Amphotericin, CBCT, Maxilla
Background: Together with COVID-19 infection, we saw an outbreak of COVID associated mucormycosis (CAM). These patients were treated with antifungals, aggressive surgery, control of diabetes and other predisposing factors. But as demand increased, there was shortage of antifungals. So patients underwent relapses. The aim of study was to evaluate the causes and relevant factors predisposing to recurrence and tools used to evaluate recurrence and extent of disease in relation to primary disease.
Methods: Prospective study of 160 CAM patients who were discharged successfully after surgery and kept under regular follow up by endoscopy, CRP, blood sugar monitoring.
Results: Our study of 160 follow up cases of CAM in whom 21 patients had recurrence. There were 18 males and 3 females. The most common affected was between 50-60 years. 67% of recurrent cases had poor diabetic control, 81% suspicious of recurrence in endoscopy, 86% showed rising trend in CRP (>5 mg/dl). These patients were further evaluated with radiological investigations like MRI and CBCT (cone beam CT). MRI detected recurrence in 38% whereas CBCT detected 62%. Most common site of recurrence was maxilla. All recurrent cases underwent surgical debridement and were given 5 gm of liposomal amphotericin.
Conclusions: Mucormycosis is an invasive fungal disease. COVID patients in whom immunological status are altered, diabetic or immunocompromised should be kept under surveillence by endoscopy, CRP and blood sugar monitoring. Though CAM patients are treated with surgery and antifungals, they should be under regular follow up for more than 6 months. Diabetic control helps in curbing the rapid spread of CAM. Suspected cases should undergo radiological investigations like MRI and CBCT. Recurrent/residual disease of mucormycosis can be tackled and treated successfully.
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