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Mucormycosis in COVID Diabetic Patients: A Horrifying Triad!

Parshika Panwar1, Anish Gupta2, Amit Kumar3

  • 1Department of General Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|December 6, 2021
PubMed

Insights

COVID-19 and uncontrolled diabetes create a dangerous environment for invasive fungal infections like mucormycosis. Early detection and treatment with antifungal medications and surgery are crucial for managing this severe complication.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Ophthalmology

Background:

  • COVID-19 is associated with an increased risk of secondary infections, including invasive fungal infections.
  • Diabetic patients and those who are immunocompromised are particularly susceptible to opportunistic pathogens.
  • Mucormycosis is a rare but aggressive fungal infection affecting the sinuses, eyes, and brain.

Observation:

  • This study reports on seven cases of rhino-orbital mucormycosis in patients recently infected with COVID-19 and with uncontrolled diabetes.
  • Patients presented with symptoms suggestive of invasive fungal sinusitis and orbital involvement.
  • Diagnosis was confirmed through clinical examination and imaging studies.

Findings:

  • All seven patients underwent emergency surgical debridement to remove infected tissue.
  • Treatment included the administration of liposomal amphotericin-B, a potent antifungal medication.
  • The study highlights a 'lethal triad' of factors contributing to mucormycosis development: COVID-19-induced immunosuppression, hyperglycemia, and the use of steroids and broad-spectrum antibiotics.

Implications:

  • Healthcare professionals must maintain a high index of suspicion for invasive fungal infections, particularly mucormycosis, in diabetic COVID-19 patients on steroid therapy.
  • Prompt surgical intervention and appropriate antifungal treatment are essential for improving outcomes.
  • Understanding the predisposing factors is key to preventing and managing this devastating coinfection.
Keywords:
COVIDDiabetes mellitusHyperglycemiaMucormycosisSteroid

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