A Rare Indolent Course of Rhinocerebral Mucormycosis

Abstract

Mucormycosis is a highly invasive and rapidly progressing form of fungal infection that can be fatal. The infection usually begins after oral or nasal inhalation of fungal spores and can enter the host through a disrupted mucosa or an extraction wound. The organism becomes pathogenic when the host is in an immunocompromised state. There are several clinical presentations of mucormycosis including rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and miscellaneous forms. The most common clinical presentation of mucormycosis is the rhinocerebral form which has a high predilection for patients with diabetes and metabolic acidosis. An indolent disease course taking weeks to months of this infection is rare making it difficult to diagnose. Therefore, early detection and prompt treatment with surgical and antifungal therapy are very important in achieving good treatment outcomes.

Changing Spectrum of Invasive Fungal Infections of the Anterior Skull Base

“…It was also seen that those patients with active infection had a poorer prognosis than those who presented after recovering from covid 19 infection (5). 98% of patients with both the acute and chronic variants of ROCM had DM (p<0.005) with similar findings encountered in the literature (10,(14)(15)(16)20). In patients with newly diagnosed DM, it was studied that insulin resistance develops secondary to cytokine storm due to the covid-19 infection, which, combined with steroid therapy, pushes the patient into a severely immunocompromised state predisposing to opportunistic infections (21).…”

“…5 Ninety-eight percent of patients with both the acute and chronic variants of ROCM had DM (p < 0.005) with similar findings encountered in the literature. 10,[14][15][16]20 In patients with newly diagnosed DM, it was studied that insulin resistance develops secondary to cytokine storm due to the COVID-19 infection, which, combined with steroid therapy, pushes the patient into a severely immunocompromised state predisposing to opportunistic infections. 21 The rampant use of steroids to treat the inflammatory sequelae of COVID-19 infection was an added burden to the already compromised immunity.…”

Post COVID 19- mucormycosis and osteomyelitis of the mandible- A rare case report

“…Management of such post covid Mucormycosis should be early diagnosis, reversal of the underlying cause, controlling blood sugar level, surgical debridement of the infected bone and medicinal management includes Antifungal drugs like Inj Amphotericin B deoxycholate with maximum tolerated dose being, 1 to 1.5mg/kg/day for 21 days dose depending on patients' body weight, Tab/syrup Posaconazole 300mg BD, Day 1 followed by 300mg OD for 2 weeks. 10 Hyperbaric oxygen therapy should also be considered which increases oxygen pressure at infected or necrosed bone region and increases neutrophil capacity for phagocytosis as well as causes neo angiogenesis and also it reverses Lactic acidosis and hence increases the rapid recovery hence 100% oxygen saturation for about 90-120 minute with pressure of about 2.0 to 2.5 atmospheric pressure is recommended. 11 Patients diagnosed with COVID 19 should be timely evaluated for the blood coagulation profile, all the patients should keep on anticoagulant as in COVID 19 patient thrombosis is the main reason which hampers the blood supply to the jaw bone and other body parts as well.…”

Black Fungus an Escalating Threat for Covid-19 Patients Calling Out Captivation

“…Moreover, depending upon the underlying condition, it can be mild to severe in intensity. Hence, the decision for management depends upon the cause and severity of signs and symptoms [2].…”