Mucormycosis
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This document discusses fungal infections that have emerged post-COVID-19, including black fungus (mucormycosis), yellow fungus (aspergillosis), and white fungus (candida). It notes that mucormycosis is an aggressive fungal infection affecting immunosuppressed patients. Cases have significantly increased during the COVID-19 pandemic. Risk factors include recent severe COVID-19, diabetes, steroid use, prolonged ICU stays, and trauma. Symptoms vary depending on infection site but may include nasal blockage, eye swelling, black lesions. Prevention strategies and treatment guidelines are referenced.
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Mucormycosis
- 1. Fungal Infections Post COVID19 Dr Rishabh Kumar Rana Assistant Professor , Department of Community Medicine SNMMCH , Dhanbad https://drrishabhkumarrana.com
- 2. Black Fungus/ Mucormycoses Yellow Fungus / Aspergillus White Fungus / Candida
- 3. Agent - Mucormycosis • Mucormycosis or zygomycosis, also called phycomycosis, initially described in 1885 by Paltauf, is an uncommon and aggressive fungal infection that usually affects patients with alteration of their immunological system. • It is a lethal fungal disease, with rhinocerebral presentation being its most common form. Although it has a low incidence rate, varying from 0.005 to 1.7 per million population, many cases have been seen recently, amounting to a significant increase in its incidence in the wake of the ongoing coronavirus pandemic Arnáiz-García ME, Alonso-Peña D, González-Vela Mdel C, García-Palomo JD, Sanz-Giménez-Rico JR, Arnáiz-García AM. Cutaneous mucormycosis: report of five cases and review of the literature. J Plast Reconstr Aesthet Surg 2009;62:e434–41
- 4. What happened earlier • Like SARS-CoV and Middle East respiratory syndrome, SARS-CoV-2 is also responsible for lower respiratory tract infection and can cause acute respiratory distress syndrome. • Besides the diffuse alveolar damage with severe inflammatory exudation, Covid-19 patients always have immunosuppression with a decrease in CD4+ T and CD8+ T cells. • During the SARS-CoV infection spread in 2003, the incidence of fungal infection was 14.8–27 per cent, and it was the main cause of death for severe acute respiratory syndrome patients, accounting for 25– 73.7 per cent in all causes of death. Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020;92:568–76
- 5. ALERT !!! • Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus 2020;12:e10726 • Werthman-Ehrenreich A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med 2021;42:264.e5–264.e8
- 6. The Publication Base of My PPT till now
- 7. Risk Factors • 1. Case of concurrent or recently (<6 weeks) treated Severe COVID-19 • 2. Uncontrolled diabetes mellitus, Chronic granulomatous diseases, HIV/AIDS, or primary immunodeficiency states • 3. Use of Immunosuppression by steroids (any dose use for >3weeks or high dose >1week), Tocilizumab, other immunomodulators, or therapy used with transplantation • 4. Prolonged neutropenia • 5. Trauma, Burns, IV drug abusers • 6. Prolonged ICU stay 7. Post-transplant/malignancy (solid or Hemopoietic) 8. Voriconazole therapy, Deferoxamine or other iron overloading therapy • 9. Contaminated adhesive bandages, wooden tongue depressors, adjacent building construction, and hospital linens • 10. Renal failure, diarrhea, and malnutrition in low-birth-weight infants/even children/adults • 11. Voriconazole Therapy
- 9. Pics of Patients with Rhino Orbital Infection from Mucor – Black Fungus
- 10. Types • 1. Rhino-orbito-cerebral mucormycosis (ROCM) Nasal stuffiness, foul smell, epistaxis, nasal discharge, unilateral facial oedema, diplopia, proptosis, pain and redness around eyes and/or nose, loss of vision, restriction of eye movements, palatal or palpebral fistula, blackish discolouration over bridge of nose/palate, prolonged Fever, headache, toothache, loosening of teeth, jaw involvement, altered mental status • 2. Cutaneous and soft tissue mucormycosis Erythema, induration, then black eschar at trauma/puncture site, muscle pain with deeper involvement • 3. Pulmonary mucormycosis Refractory fever on broad-spectrum antibiotics, non- productive cough, progressive dyspnea, pleuritic chest pain • 4. Gastrointestinal mucormycosis Fever, bleeding per anus, masslike lesions, then perforation of gut • 5. Mucormycosis of bones and joints Local pain and tenderness, cellulitis, fever is rare • 6. Disseminated mucormycosis Symptoms vary as per site of involvement, mostly associated with pneumonia
- 14. References • Guidelines for Mucor ICMR. • Guidelines for Treating Mucor West Bengal State Guidelines. • Guidelines for Treating Mucor AIIMS RISHIKESH Guidelines. • Evidence Based Advisory In The Time Of Covid-19: Available from: https://www.icmr.gov.in/pdf/covid/techdoc/Mucormycosis_ADVISOR Y_FROM_ICMR_In_COVID19_time.pdf