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Post Covid-19 Infection Presenting as Rhino-Orbital Mycosis
Richa Garg1, Sandeep Bharangar2, Sunil Gupta3
1Consultant Pathologist, Crest Hospital, Moradabad, Uttar Pradesh India.
Abstract:
Rhino-orbital mycosis has been recently recognised as one of the sequelae in COVID-19 recovered patients. In India, detection of mucormycosis is declared as notifiable disease. In this article, the authors aim to describe the characteristics of patients presenting with post covid fungal infection which could be detected on 10% potassium hydroxide (KOH) wet mount and Giemsa stain put on crush biopsy smear. We describe 10 COVID-19 recovered patients admitted to ENT department of the hospital during second wave of COVID-19 infection. They presented with post covid fungal sinusitis and ophthalmic complications and planned for surgery. KOH mount and Giemsa stain were used for possible opinion and confirmed by culture. The observations were described in mean and percentages. All ten (100%) COVID-19 recovered patients were previously diagnosed with type 2 diabetes mellitus (DM) for 2-11 years. All 10 patients (100%) were given oral or intravenous corticosteroids for mean of 21 days (3 weeks-till presentation to ENT department). Simple procedures with 10% KOH mount and Giemsa stain could detect fungal hypae in all the cases and could provide possible opinion in 9 of 10 (90%) cases for timely management of the patients. The authors hypothesize that uncontrolled DM and prolonged use of corticosteroids may act as culprits of rhino-orbital mycosis in COVID-19 recovered patients. Simple and routine 10% KOH mount and Giemsa stain may provide early opinion of fungal hypae to ensure quick management and survival of the patients.
Insights
Post-COVID rhino-orbital mycosis is a growing concern. Simple 10% potassium hydroxide (KOH) wet mount and Giemsa stain effectively detected fungal hyphae in recovered COVID-19 patients, aiding timely management.
Area of Science:
- Infectious Diseases
- Ophthalmology
- Mycology
Background:
- Rhino-orbital mycosis is an emerging complication in COVID-19 survivors.
- Mucormycosis detection is a notifiable disease in India.
- Fungal infections post-COVID-19 require prompt diagnosis and management.
Purpose of the Study:
- To characterize patients with post-COVID fungal infections.
- To evaluate the efficacy of 10% potassium hydroxide (KOH) wet mount and Giemsa stain in diagnosing rhino-orbital mycosis.
- To identify risk factors associated with post-COVID fungal sinusitis.
Main Methods:
- Descriptive study of 10 COVID-19 recovered patients.
- Diagnosis of fungal sinusitis and ophthalmic complications.
- Microscopic examination using 10% KOH wet mount and Giemsa stain on crush biopsy smears.
- Fungal culture for confirmation.
Main Results:
- All 10 patients had a history of type 2 diabetes mellitus (DM).
- All patients received corticosteroids for a mean duration of 21 days.
- 10% KOH and Giemsa stain detected fungal hyphae in 100% of cases, providing a diagnosis in 90%.
Conclusions:
- Uncontrolled diabetes mellitus and prolonged corticosteroid use are hypothesized as key factors in rhino-orbital mycosis development post-COVID-19.
- Routine 10% KOH and Giemsa stains are valuable for early detection of fungal hyphae.
- Early diagnosis through simple methods can improve patient outcomes and survival.
