Publication:

Mucormycosis during the second wave of COVID-19 in India

Background The so called “black fungus epidemic” struck India during the second wave of COVID-19 pandemic. Large numbers of patients were being reported, posing a challenging situation for clinicians. The treatment options were limited, and rescue surgery was mutilating, anti-fungal medicines became short of supply soon, prognosis remained poor. Objective was to understand a unifying pathophysiological picture with a framework to check this post Covid epidemic, especially in context with South-east-Asia.

Methods The clinical, radiological, surgical data of patients presented with symptoms of rhino-orbito-cerebral complications, collected and analyzed.

Results 80.9% of operated patient had thrombosis of identifiable major vessels. The 76.7% patient had cerebral venous thrombosis. The 30% patient had internal carotid artery narrowing on imaging. Fungal staining was positive in 72% patient. We found level of D dimer was high in 81.3% patients and 83.9% patients had blood sugar level raised at the time of presentation.

Conclusions Hyper thrombotic state of COVID-19 in diabetes and injudicious use of steroids predisposed susceptible patients to thromboembolic phenomena, leading to necrosis of tissue and secondary fungal infection.