INCIDENCE OF SINO NASAL MUCORMYCOSIS IN ACTIVE & POST COVID- 19
PATIENTS AT A DISTRICT LEVEL HOSPITAL – A PROSPECTIVE STUDY
Abstract
Objective: To study the incidence of sinonasal mucormycosis in active
and post COVID-19 patients in a district-level hospital in India. Study
Design: A prospective, interventional cohort study conducted from April
2021 to January 2022. Setting: A district-level/secondary level hospital
in North India. Methods: Inclusion Criteria: All COVID-19 positive
patients with diabetes mellitus as co-morbidity and with at least one of
the following:received steroid therapy and/or on high flow oxygen
therapy and/or had prolonged hospital stay (>7 days).
Exclusion Criteria: Patients already immunocompromised/having
malignancy/organ transplant recipients. Clinical workup: History,
examination, imaging (CECT/MRI nose and paranasal sinuses if indicated),
diagnostic nasal endoscopy + Nasal scrapings for KOH mount to detect
fungal elements. Results: Fourteen out of 250 patients tested positive
for Mucormycosis (incidence 5.6%). Out of these 13 were symptomatic and
only one patient was asymptomatic and detected on screening. No
significant difference was found in mucormycosis vs. non-mucormycosis
group with respect to HbA1c status, vaccination status or steroid +
oxygen treatment (p>0.05 in all scenarios). Patients were
treated with intravenous Liposomal Amphotericin B and surgical
debridement when indicated. Two succumbed to disease (survival 85.7%).
A clinical screening protocol was thus developed which can be used as an
effective tool even at far-flung and remote healthcare facilities for
diagnosis and timely referral of patients. Conclusion: Mucormycosis is a
potentially lethal disease which needs rapid diagnosis and timely action
to decrease morbidity and mortality.