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Published on: April 19, 2024
Management of COVID associated invasive fungal sinusitis
Dr Sampurna Ghosh1, Dr Neha Padia2
1Medicover Hospitals, Hyderabad, Telangana, India.
Introduction:
Mucormycosis is a life-threatening infection caused by fungi belonging to the order mucorales. Aspergillous and Mucormycetes have been reported as the main fungal pathogens for infection in people with COVID-19. The main risk factors include uncontrolled Diabetes mellitus and steroid use.
Aim:
The current study aims to analyze the diagnostic indicators, treatment protocols and follow up approach in patients who were affected with post-COVID mucormycosis.
Methods:
Patients who were admitted to Medicover hospitals with acute sinusitis symptoms were included in the study. Data was collected using a structured proforma which included demographic details, past medical history, days of presentation from COVID-19 diagnosis and symptoms related to eyes, nose and mouth. We noted the Magnetic resonance imaging and Computed tomography findings and blood parameters like Total leukocyte count, C-reactive protein, Erythrocyte sedimentation rate, Glycated hemoglobin and creatinine were monitored. All patients were divided into stages and underwent relevant surgical procedures along with, anti-fungal therapy. Follow up was conducted to see for residual or recurrent disease and survival until 1 year post admission.
Results:
Total of 23 patients were studied. 17 male and 6 female. 69.5% were diabetic. 91.3% received steroids during COVID treatment. Majority presented within 4 weeks of diagnosis of COVID. CT-SCAN and MRI findings formed the road-map to treatment. All 23 were confirmed mucormycosis based on biopsy reports, but 4 had overlapping Aspergillous infection. All patients were started on amphotericin-B and followed up for disease free status and survival up 1 year. We also monitored CRP levels to declare disease free status.
Conclusion:
The poor and impaired immune functioning due to COVID infection along with unmonitored use of steroids, was the major cause of rise in mucormycosis. We now know that successful treatment of mucormycosis requires early diagnosis, reversal of underlying predisposing risk factors, surgical debridement and prolonged antifungal therapy.
Insights
Post-COVID mucormycosis is a serious fungal infection linked to uncontrolled diabetes and steroid use during COVID-19 treatment. Early diagnosis, surgical intervention, and antifungal therapy are crucial for successful outcomes.
Area of Science:
- Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Mucormycosis is a life-threatening fungal infection caused by Mucorales, posing a significant risk to COVID-19 patients.
- Key risk factors for mucormycosis include uncontrolled Diabetes Mellitus and the use of corticosteroids.
- Co-infections with Aspergillus and Mucorales species are frequently observed in COVID-19 patients.
Purpose of the Study:
- To analyze diagnostic indicators for post-COVID mucormycosis.
- To evaluate treatment protocols and follow-up strategies for patients with mucormycosis following COVID-19 infection.
Main Methods:
- A study included 23 patients admitted with acute sinusitis symptoms post-COVID-19.
- Data collection involved demographic details, medical history, symptom onset, and imaging (MRI, CT-SCAN).
- Blood parameters (leukocyte count, CRP, ESR, HbA1c, creatinine) were monitored; patients received surgical procedures and antifungal therapy (Amphotericin-B).
Main Results:
- The study cohort comprised 17 males and 6 females, with 69.5% having diabetes and 91.3% receiving steroids during COVID-19 treatment.
- Most patients presented within 4 weeks of COVID-19 diagnosis; CT-SCAN and MRI guided treatment.
- All patients were confirmed for mucormycosis via biopsy, with 4 cases showing co-infection with Aspergillus; all received Amphotericin-B and were monitored for 1 year.
Conclusions:
- Impaired immunity from COVID-19 and unmonitored steroid use significantly contributed to the rise in mucormycosis.
- Successful mucormycosis treatment necessitates early diagnosis, management of predisposing factors, surgical debridement, and extended antifungal therapy.
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