MUCORMYCOSIS IN POSTCOVID ERA: DIAGNOSTIC AND THERAPEUTIC CHALLENGES

Background : Mucormycosis, first identified in 1885, has surged in incidence, especially post-COVID-19, primarily affecting immunocompromised individuals such as those with uncontrolled diabetes and patients undergoing chemotherapy. The immunosuppressive effects of COVID-19 and steroid treatments that cause temporary hyperglycemia have heightened the risk. Additionally, factors like nasal mucosa drying and unsterilized oxygen delivery may contribute to its spread. The aim of this study is to study the various clinical presentations and management of mucormycosis in the post-COVID era and educate the clinicians in early diagnosis and treatment of this fateful disease. METHODOLOGY Clinically suspected and histologically reported 117 cases of mucormycosis depending upon their clinical presentation, nasal endoscopy, and radiological evidences were included in this study. Pus culture and sensitivity of sinus discharge as well as fungal staining by KOH mount were done. MRI were done in all cases to understand the extent of disease. Endoscopic surgical debridement was choice of surgical intervention followed by histopathological examination and administration of injection liposomal amphotericin B. All cases diagnosed as mucormycosis such as mixed fungal infection with mucormycosis as well as isolated mucormycosis were included in this study and all other types of fungal infections were excluded from this study. RESULTS Out of 117 patients with mucormycosis, 71 had paranasal sinus involvement, 27 had sinus with palatal complications, 28 had orbital involvement, 18 experienced intracranial involvement, and 8 had mixed presentations. Of the patients, 102 (87.17%) were immunocompromised, emphasizing the need for careful monitoring.81 patients fully recovered, 27 experienced some morbidity, 5 lost follow-up, and 4 passed away. Management included endoscopic surgical debridement along with administration of liposomal amphotericin B. Orbital decompression or exenteration and partial or total maxillectomy was required in certain cases depending on the clinical and radiological presentation. Post-COVID, clinicians Conclusion : should be alert to the possibility of mucormycosis in cases of fungal sinusitis until ruled out. Recognizing specific symptoms is crucial, and while endoscopy and MRI are key diagnostic tools, attention to ocular, palatal, and intracranial signs is essential. A low threshold for initiating Amphotericin B treatment is important, as mucormycosis can affect even otherwise immunocompetent patients who may experience sudden rise in blood sugar level after use of steroids or any other cause in COVID-19. A multidisciplinary approach is vital for effective management.