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A Case Series of Rhino-Orbital Mucormycosis in COVID-19 Patients

A Case Series of Rhino-Orbital Mucormycosis in COVID-19 Patients

K S Dinesh and R Vanitha

Journal Title:Acta Scientific Otolaryngology

Mucormycosis is caused by filamentous fungi of Mucor, Rhizopus, Absidia, Apophysomyces, Saksenae and Cunninghumella of the Mucorales order. Mucormycosis was first described by Paultauf A in 1885. Neutrophils play a key role in the host defence against mucormycosis. Ketoacidosis, hyperglycemia and hypoxia are excellent growth conditions for mucormycosis. Impairment of phagocy- tosis due to immunosuppression causes germination of spores into hyphae resulting in angio-invasion. Recently, the surge in mucor- mycosis is linked to the second wave of COVID-19 infection mostly due to uncontrolled diabetes in patients managed with steroids. India has emerged as being the mucormycosis capital in recent times. In this study report, we present the clinical findings and therapeutic outcomes of rhino-orbital mucormycosis in 3 male patients, age range between 45 - 75 years old all had diabetes mellitus and underwent treatment for COVID-19 pneumonia. All patients developed proptosis, sinusitis and decreased visual acuity with no light perception in the two patients with severe orbital involvement. Histopathological examination of tissue biopsy revealed typical Mucor hyphae. Systemic liposomal amphotericin B was initiated in all patients. The patients with limited ocular involvement received amphotericin B both intravenously and by local irrigation; one patient had complete recovery. All 3 patients underwent functional endoscopic sinus surgery (FESS) with orbital decompression and one patient needed orbital exenteration. One patient died after declining systemic treatment postoperatively. Early diagnosis and intervention with antifungal medication and surgical clearance of the disease may help avoid mutilating surgery like exenteration. Basic safety precautions like proper use of mask, single use of oxygen tube, using distilled water, hand washing and social distancing will go hand in hand to prevent the fulminant nature of the disease. Long term monitoring of patients is essential for favorable outcome. Keywords: Mucormycosis; COVID-19; Diabetes Mellitus; FESS; TRAMB