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Triad of COVID-19, Diabetes mellitus and Mucormycosis: A mere coincidence or a Real Association ?

Arthi Srinivasan

Background

COVID-19 patients, especially severely ill or immunocompromised, have a higher probability of suffering from invasive mycoses. As a life-threatening infectious disease, COVID-19 patients showed overexpression of inflammatory cytokines, and impaired cell-mediated immune response with decreased CD4 + T and CD8 + T cell counts, indicating its susceptibility to fungal co-infection. Early diagnosis of mucormycosis is of utmost importance as studies have shown that it increases survival and it may also reduce the need for or extent of surgical resection and suffering. The chances for recovery from mucormycosis are low, despite early diagnosis and intensive combination surgical and medical therapy and the mortality of mucormycosis remains high.

Aim

The aim of the study is to analyse the clinical features and the severity of mucormycosis in post COVID-19 patients

Materials and Methods

A total of 12 patients were included in this study and all were tested positive for COVID and hospitalized. The data recorded were demographic variables, clinical features including the underlying systemic complications and COVID status, treatment done and the follow up of patients.

Results

All cases were histopathologically / cytologically reported as mucormycosis. The age of occurrence was in the range of 30 - 60 years. Males outnumbered females by a ratio of 11:1. Majority of the cases occurred in the fifth decade of life irrespective of gender. Eight cases (67%) had multiple swellings seen in the attached gingiva in maxilla. Orbital and cranial involvement was found in 60% of cases and necrosis of the maxilla was present in all the cases. Restricted mouth opening was seen in 70% of cases. Hypertension was seen in 25% of cases and there was a 91% incidence of diabetes mellitus. Fatality was seen in two cases.

Conclusion

With the cumulative clinical data collected from the following 12 cases a positive identification of mucormycosis following COVID-19 was made. The risk factors associated with the disease were identified as diabetes mellitus, COVID infection, hospitalization and also the steroid therapy involved in the treatment protocol of COVID-19 patients. Early diagnosis of the disease could improve the chance of survival of the patients.