Mucormycosis during COVID-19 era

Backgrounds and Aims: In April − May 2021, India has witnessed a large number of cases of mucormycosis during the second wave of COVID-19 infection both in recovered patients and those in the active phase of disease. Poorly controlled diabetes mellitus, drugs-induced immunosuppression, posttransplantation, and hematological malignancies are the major risk factors for both severe COVID-19 and mucormycosis. This unprecedented rise in COVID-19 infection led to a near collapse of the health-care system with severe shortage of treatment facilities including health-care staff and infrastructure. COVID-19 has highlighted several loopholes in the present health-care system. Most of the existing workforce had to be diverted to treat this disease and its complications. Our aim is to analyze the various clinicopathological characteristics of patients with mucormycosis and COVID-19 by an oncology department in association with the multidisciplinary team of a tertiary care center during the second wave of COVID-19 pandemic. Materials and Methods: A retrospective observational study was conducted at the oncology ward of a tertiary care center. All biopsy-proven mucormycosis patients were enrolled in the study. A detailed history along with comprehensive clinical examination and imaging studies was done. Surgical intervention and medical management were done by a multidisciplinary coordination team as per the ICMR protocol. Results: Forty-five patients were enrolled in the study. All cases of mucormycosis occurred in COVID-19 recovered patients. The median age was 52 years. Diabetes mellitus was present in 38 of 45 cases (84%). Periorbital swelling, ocular pain, ptosis, and loss of vision were the main presenting complains. The maxillary sinuses were the most common sinuses affected (45%). Intraorbital extension was seen in five cases (11%). Intracranial extension was seen in nine cases (20%). All patients had received steroids during the COVID-19 treatment. Conclusion: Poorly controlled diabetes and indiscriminate use of immunosuppressive drugs including steroids have emerged as predisposing factors for causation of mucormycosis in COVID-19 disease. In suspected cases, early initiation of therapy and rapid reversal of underlying predisposing risk factors play a key role.