COVID-19 triggering rare but deadly fungal infection: Ganga Ram Hosp
New Delhi: In the last 15 days ENT surgeons at Sir Ganga Ram Hospital have seen 13 cases of Covid triggered Mucormycosis with over 50% patients' with loss of eyesight and removal of nose and jaw bone. "The shocking frequency with which we are witnessing the occurrence of COVID-19 triggered mucormycosis with high morbidity and mortality has never been seen before and is alarming" said Dr Manish Munjal, a senior ENT surgeon at the hospital.
As per the Centre for Disease Control (CDC), Mucormycosis (also called black fungus) is a serious but rare fungal infection caused by a group of molds (called mucormycetes) and mainly affects immune-compromised people. While this infection itself is not new, its occurrence in patients recovering from COVID-19 is.
Of the 13 cases reported by SGRH, the hospital's ENT and eye team has done resections (cut out tissue/parts of organs) in about 10 patients over the last fortnight, with about 50% losing their eyesight permanently. Five of these patients required critical care support, due to associated complications while 5 have died, mostly those in whom the infection had reached the brain.
The hospital also cited the case of a 32-year-old mildly diabetic West Delhi businessman who reported a fever on November 20 and tested positive for COVID-19 soon after. The fever lasted four days and led to excessive coughing, breathing problems and decline in his oxygen saturation levels. He was then hospitalised and administered antiviral Drugs, IV steroids, oxygen support and supplements. After 7 days, he tested negative for COVID-19 and was discharged.
However, a nagging obstruction in the left nostril, which became a swollen eye in two days made him consult doctors again. Rather than responding to antibiotics and painkillers, he started rapidly losing vision on the affected side. The whole left side of the face became completely numb and he was brought to the hospital emergency in a partially disoriented and obtunded state.
Tests revealed steeply elevated sugar and infection levels and the presence of a killer rare fungus called Mucor, which was sampled from his nose debris. An MRI revealed that the infection had already destroyed a significant part of his left side sinuses, eye, upper jaw bone and muscles, and had made passage into the brain.
An extensive surgical debridement was undertaken by a team of ENT and eye surgeons, he was put on antifungal medication and critical care support for more than two weeks, and will soon be discharged in a survivable, but disfigured state.
"Early clinical suspicion on symptoms such as nose obstruction, swelling in the eye or cheeks, and black dry crusts in the nose should immediately prompt the conduct of a biopsy in the OPD and start of antifungal therapy as early as possible", Dr Munjal says.
"We have to carefully elevate the antifungal dosage to more than maximum (suprathreshold) levels, without letting the internal organs face the damage, says Dr Prakash Shastri, Vice Chairman of Critical Care, at Sir Ganga Ram Hospital.