COVID TRIGGERING RARE BUT DEADLY MUCORMYCOSIS

High rate of mortality, loss of eyesight & jaw, seen at Sir Ganga Ram Hospital

New Delhi : In last 15 days ENT surgeons at Sir Ganga Ram Hospital have seen 13 cases of Covid triggered Mucormycosis with over 50% patients’ with loss of eyesight and removal of nose and jaw bone.

Mortality is currently being seen in the range of 50% (5 patients) with certain deaths when there is involvement of brain.

According to Dr. Manish Munjal, Senior ENT surgeon, Sir Ganga Ram Hospital, “The frequency with which we are witnessing the occurrence of Covid triggered mucormycosis with high morbidity & mortality has never been seen before and is shocking and alarming”.

32 year old Rajesh (name changed) was a full of life, hard working businessman of West Delhi, who did not worry too much about a bout of fever that stuck him on the evening of 20th November when he returned home. But for the sake of his elderly parents at home, and a little concern due to his mild diabetic condition, he volunteered for a Corona test, which returned positive the next day. The fever refused to break for 4 days and then lead to excessive cough breathing problem and decline in his Oxygen saturation levels. He was appropriately advised admission at the nearby Covid hospital where he was administered a Cocktail of Antiviraldrugs, IV steroids, Oxygen support and supplements. Eventually after a period of 7 days, he was discharged from the hospital in afebrile state, with no requirement for Oxygen and of course, after a Covid negative test.

A nagging left side nose obstruction, which rapidly became an eye swelling in a matter of 2 days, made him reach his doctors again. But rather than respond to antibiotics and painkillers that were initiated, he started rapidly losing vision on the affected side. The whole left side of the face became completely numb and he was brought to the hospital emergency in a partially disoriented and obtunded state. His tests revealed the presence of steeply elevated sugar and infection levels, but even more deadlier, the presence of a killer rare Fungus called Mucor, which was sampled from his nose debris. An MRI revealed that the infection had already destroyed a significant part of his left side Sinuses, eye, upper jaw bone and muscles, and even had made passage into the brain! An extensive surgical debridement was undertaken by a team of ENT and Eye surgeons, and he had to be subsequently put on Life saving Antifungal medication and vital Critical care support for more than 2 weeks, will soon be discharged in a survivable, but a disfigured state.

This alarming affliction, although rare, is not new. What is new is Covid which is triggering Mucormycosis.

Black Fungus, or Mucormycosis has been a cause of disease and death in Transplants, ICU and Immunodeficient individual since long, however it is the rapid increase in numbers seen in unsuspected so called recovering Covid patients that is causing the grave concern.

The ENT and Eye team at Sir Ganga Ram have had to do these resections in about 10 patients over the last fortnight, with about 50% losing their eyesight permanently. 5 of these patients required critical care support, due to associated complications. There also have been 5 unfortunate mortalities so far in this subgroup.

According to Dr Manish Munjal, Senior ENT surgeon, Sir Ganga Ram Hospital along with Dr Varun Rai, Consultant ENT surgeon, Sir Ganga Ram Hospital says, “Early Clinical suspicion on symptoms such as nose obstruction, swelling in the eye or cheeks, and black dry crusts in the nose should immediately prompt the conduct of a biopsy in the OPD and start of the Antifungal therapy as early as possible”.

According to Dr Shaloo Bageja, Senior Eye surgeon, Sir Ganga Ram Hospital adds, ”Orbital involvement is a grave development in the course of this disease, and points not only towards the possibility of permanent loss of eyesight but life as well, because brain involvement is the leading cause of death in mucormycosis.”
The early diagnosis requires early reporting.

Dr Jasvinder Kaur, Clinical Mycologist, Sir Ganga Ram Hospital says,” Early identification by microscopy of the deadly Aseptate mucor hyphae fungus in fresh specimens is the key to the start of appropriate antifungals.”

Finally, it’s a herculean task to revive the immunocompetence of a weak COVID patient.

“Most important is that we have to carefully elevate the dosages of Antifungals to more than maximum (suprathreshold) levels, without letting the internal organs like kidney and liver facing the damage, says Dr Prakash Shastri, Vice Chairman of Critical Care, Sir Ganga Ram Hospital team at the hospital.

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