DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20220809

Post surgery mucor recurrence in COVID-19 associated mucormycosis patients of a tertiary care centre

Kavita Sachdeva, Lakshmy V. Raj, Stephy Maria Tom, Diksha Sharma, Amrita Shukla, Mayur V. Kabade

Abstract


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.


Keywords


COVID associated mucormycosis, Amphotericin, CBCT, Maxilla

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References


Rao VUS, Arakeri G, Madikeri G, Shah A, Oeppen RS, Brennan PA. COVID-19 associated mucormycosis (CAM) in India: a formidable challenge. Br J Oral Maxillofac Surg. 2021;59(9):1095-8.

Shastry SP, Murthy PS, Jyotsna TR, Kumar NN. Cone beam computed tomography: a diagnostic aid in rhinomaxillary mucormycosis following tooth extraction in patient with diabetes mellitus. J Indian Acad Oral Med Radiol. 2020;32(1):60-4.

Pagare J, Johaley S. Diagnostic role of CBCT in fulminating mucormycosis of maxilla. Int J Res Rev. 2019;6(7):575-9.

Honavar SG. Code mucor: guidelines for the diagnosis, staging and management of rhinoorbito-cerebral mucormycosis in the setting of COVID-19. Indian J Ophthalmol. 2021;69(6):1361-5.

Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia. 2020;185(4):599-606.

Sreshta K, Dave TV, Varma DR, Nair AG, Bothra N, Naik MN, et al. Magnetic resonance imaging in rhino-orbital-cerebral mucormycosis. Indian J Ophthalmol. 2021;69(7):1915-27.

Gamba JL, Woodruff WW, Djang WT, Yeates AE. Craniofacial mucormycosis: assessment with CT. Radiology. 1986;160(1):207-12.

Herrera DA, Dublin AB, Ormsby EL, Aminpour S, Howell LP. Imaging findings of rhinocerebral mucormycosis. Skull Base. 2009;19(2):117-25.

Arani R, Shareef SNHA, Khanam HMK. Mucormycotic osteomyelitis involving the maxilla: a rare case report and review of the literature. Case Rep Infect Dis. 2019;2019:8459296.

Niranjan KC, Sarathy N, Alrani D, Hallekeri K. Prevalence of fungal osteomyelitis of the jaws associated with diabetes mellitus in North Indian population: a retrospective study. Int J Curr Res. 2016;8:27705-10.