The recent increase in cases of post-COVID Mucormycosis | Clinicia

by Dr. Amol Ghaisas, Maxillofacial Surgeon practicing in Mumbai

As the COVID pandemic is making all of us struggle in different ways, I would like to put some light on the recent blast in cases of post-COVID Mucormycosis.

Mucormycosis is a type of fungal infection caused by fungi in the order Mucorales. Airborne spores land on nasal/oral mucosa if immunologically incompetent spores are not contained by phagocytic response and gemination ensues.

Causes

The exact cause of post-COVID Mucormycosis is unknown but it may be because of immunosuppression caused by

COVID
underlying systemic disease s/a DM
High dose Steriods
Drug-induced – remdesivir, toclizumab
Or because of an increase in serum iron load seen because of inflammation due to cytokine storm in COVID cases.

It mostly affects maxilla but some mandibular cases are also being reported.

Signs and symptoms

Mobility in teeth with or without periodontal abscess
OpG may be completely normal
Nasal discharge
Palatal or nasal mucosa necrosis or black eschar
Perforation in palatal mucosa
Sinusitis
Low-grade fever

Mucormycosis spread is rapid and can affect maxillary alveolus, maxillary sinus, orbit, and eventually, intracranial involvement can take place.

As it spreads upwards it can cause chemosis, proptosis, blindness, cavernous sinus thrombosis, cerebral ischemia, infarction, and death.

As toothaches or extraction can be associated with the onset of symptoms dentist should be extremely vigilant in diagnosing such cases. Thus history undertaking and prompt consultation play a vital role in early diagnosis.

Diagnosis

It is best diagnosed by

Fungal culture and biopsy/
Endoscopic biopsy from sinus

MRI is favorable than CT scan to diagnose soft tissues and vascular structures

Management

Management involves

Surgical part:

Surgical debridement of the affected area
Hemi / Total maxillectomy
Debridement of maxillary sinus
Orbital Excentration
Endoscopic debridement of Ethmoid , Sphenoid sinus

Medical management

Early Administration of antifungal agent

Amphotericin B with strict monitoring of serum creatinine and urea as it highly nephrotoxic

Newer agents s/a liposomal or liyophillised amphotericinB preferred as it less nephrotoxic

Dosage

Dosage is up to 5 mg/kg of body weight. Dose adjustments in view of raised creatinine are needed.

Impact

Mucormycosis is deadly and has mortality up to 50%. Without surgery, the mortality is 100%. Surgery also leads to facial deformity and subsequent rehabilitation procedures are needed. It will affect patients financially and emotionally to great extent.

Precautions

Many maxillofacial surgeons throughout India are seeing a rise in mucormycosis cases. So early diagnosis plays a vital role

Also, all post COVID patients should get a regular dental checkup done and should be asked to wear clean masks and main oral hygiene by brushing thrice daily and using mouth wash on a regular basis.