REASONS FOR MUCORMYCOSIS IN COVID-19

 


Key Take Home Messages:

§  Mucormycosis is an opportunistic devastating fungal rhino-cerebro-orbital infection which is primarily a disease of sinuses and secondary to orbit.
§  Mucormycosis are not black fungi. It is not contagious & not spread by oxygenation, humidifier and water.
§  Reasons for mucormycosis in Covid-19:
v  affection of innate immunity
v  oxidative stress
v  iron overload
v  affection of adaptive immunity
§  Risk factors for mucormycosis in Covid-19:
v  uncontrolled DM
v  high dose and early treatment with steroids/immune-modulators/mechanical ventilation
v  long standing oxygen therapy
v  tocilizumab use
v  prolonged use of broad spectrum antibiotics
v  high levels of HbA1c, IL-6 and serum ferritin.
§  Prevention:
v  Good and proper hygiene of face and oral/buccal cavity
v  No role of dehumidifier bottle fluid in this scenario, so no role of  methylene blue in these bottles
v  Good glycaemic control
v  HbA1c, IL-6, CRP, Ferritin levels are to be strictly monitored
v  Systemic steroids should not be used in mild cases of Covid.
v  Judicial use of steroids and it should be limited to dexamethasone 0.1 mg/kg/day for 5-10 days
v  Very guarded use of tocilizumab
v  No anti-fungal prophylaxis is recommended
§  Poor prognostic indicators: Facial necrosis, Hemiplegia and CNS involvement
§  Better survival outcomes with early commencement of treatment
§  Medical management:
v  Induction with L-AMB 5-10 mg/kg/day for 02 weeks
v  Dual therapy: L-AMB + Oral Posaconazole 300 mg BD on day 1 and then 300 mg OD for 02 weeks
v  Oral Posaconazole 300 mg OD for further 2-4 weeks till clinical resolution and radiological stabilization
§  Surgical management:
v  Early and complete surgical debridement (till bleeding) with clean margins of all the necrosed/devitalised tissues
v  Transcutaneous retrobulbar AMB (TRAMB) 1 ml of 3.5 mg/ml
v  Orbital exenteration-patients with extensive orbital involvement

#DrRajeshBollam 
#mucormycosis

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