Reasons For Mucormycosis In Covid-19

21 May, 2021

Dr. Rajesh Bollam

Key Take Home Messages:Â§ Mucormycosis is an opportunistic devastating fungal rhino-cerebro-orbital infection which is primarily a disease of sinuses and secondary to orbit.Â§ Mucormycosis are not black fungi. It is not contagious & not spread by oxygenation, humidifier and water.Â§ Reasons for mucormycosis in Covid-19:v affection of innate immunityv oxidative stressv iron overloadv affection of adaptive immunityÂ§ Risk factors for mucormycosis in Covid-19:v uncontrolled DMv high dose and early treatment with steroids/immune-modulators/mechanical ventilationv long standing oxygen therapyv tocilizumab usev prolonged use of broad spectrum antibioticsv high levels of HbA1c, IL-6 and serum ferritin.Â§ Prevention:v Good and proper hygiene of face and oral/buccal cavityv No role of dehumidifier bottle fluid in this scenario, so no role of methylene blue in these bottlesv Good glycaemic controlv HbA1c, IL-6, CRP, Ferritin levels are to be strictly monitoredv Systemic steroids should not be used in mild cases of Covid.v Judicial use of steroids and it should be limited to dexamethasone 0.1 mg/kg/day for 5-10 daysv Very guarded use of tocilizumabv No anti-fungal prophylaxis is recommendedÂ§ Poor prognostic indicators: Facial necrosis, Hemiplegia and CNS involvementÂ§ Better survival outcomes with early commencement of treatmentÂ§ Medical management:v Induction with L-AMB 5-10 mg/kg/day for 02 weeksv Dual therapy: L-AMB + Oral Posaconazole 300 mg BD on day 1 and then 300 mg OD for 02 weeksv Oral Posaconazole 300 mg OD for further 2-4 weeks till clinical resolution and radiological stabilizationÂ§ Surgical management:v Early and complete surgical debridement (till bleeding) with clean margins of all the necrosed/devitalised tissuesv Transcutaneous retrobulbar AMB (TRAMB) 1 ml of 3.5 mg/mlv Orbital exenteration-patients with extensive orbital involvement#DrRajeshBollam #mucormycosisBOOK APPOINTMENT

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Reasons For Mucormycosis In Covid-19

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