ABSTRACT
Pulmonary mucormycosis is a rare, life-threatening fungal infection usually seen in immunocompromised patients. Mortality in such patients is high due to underlying immunosuppression and poor general condition of the patients. Invasion of the adjacent structures is known but, to the best of our knowledge, pulmonary mucormycosis presenting with a full thickness chest wall erosion has not been reported. We report such a case with chest wall destruction with superadded bacterial infection. The use of prosthetic materials for chest wall reconstruction was not possible due to the presence of infection. In addition, there were other intra-operative and post-operative challenges which we managed using a multidisciplinary approach. This report highlights the successful outcome of this complex situation using pre-operative optimisation, adequate surgical debridement and effective management of post-operative complications with patience and perseverance.
Subject(s)
Antifungal Agents , Debridement , Lung Diseases, Fungal , Mucormycosis , Thoracic Wall , Humans , Mucormycosis/diagnosis , Mucormycosis/surgery , Mucormycosis/therapy , Thoracic Wall/surgery , Thoracic Wall/microbiology , Lung Diseases, Fungal/surgery , Lung Diseases, Fungal/diagnosis , Debridement/methods , Male , Antifungal Agents/therapeutic use , Tomography, X-Ray Computed , Immunocompromised HostABSTRACT
OBJECTIVES: To evaluate surgical outcomes of invasive fungal rhinosinusitis MATERIALS AND METHODS: The National Inpatient Sample Database (2000-2015 Q3) was queried for patients with a diagnosis of aspergillosis and/or mucormycosis and a diagnosis of acute sinusitis using the International Classification of Diseases, Ninth Edition. Factors associated with inpatient mortality were then identified with multivariate logistic regression. RESULTS: 514 adult patients with a median age of 57.0 years were identified, of which 231 (44.9 %) underwent sinus surgery. Surgical patients had a longer length of stay (17.0 vs 9.0 days, p < 0.001) and higher total charges ($139,762.00 vs $57,945.00, p < 0.001). The number of sinus procedures was associated with reduced odds of inpatient mortality (OR 0.69; p < 0.001) in multivariate analysis. Hypertension (OR 0.34, p = 0.002) and chronic kidney disease (OR 0.23, p = 0.034) were associated with reduced odds of inpatient mortality. Total number of procedures (OR 1.24; p = 0.002), mucormycosis (OR 2.75, p = 0.002), age (OR 1.03, p = 0.006) and acid-base disorders (OR 2.85, p = 0.012) were associated with increased odds of inpatient mortality. CONCLUSION: This represents the first large scale study to evaluate outcomes for invasive fungal rhinosinusitis. These findings suggest the odds of inpatient mortality decrease with greater extent of sinus surgery performed. The potentially protective roles of hypertension and chronic kidney disease should be evaluated in future research.
Subject(s)
Aspergillosis , Hospital Mortality , Mucormycosis , Rhinosinusitis , Adult , Aged , Female , Humans , Male , Middle Aged , Aspergillosis/mortality , Aspergillosis/surgery , Hypertension/complications , Hypertension/mortality , Invasive Fungal Infections/mortality , Invasive Fungal Infections/surgery , Length of Stay/statistics & numerical data , Mucormycosis/mortality , Mucormycosis/surgery , Renal Insufficiency, Chronic/mortality , Renal Insufficiency, Chronic/complications , Rhinosinusitis/microbiology , Rhinosinusitis/mortality , Rhinosinusitis/surgery , Treatment Outcome , Aged, 80 and overABSTRACT
Reconstruction of maxillary defects can be carried out using a variety of treatment modalities. The choice of modality depends on numerous factors, including the size and extent of the defect, patient characteristics, and existing comorbidities. One of the various options is reconstruction and rehabilitation using a fixed prosthesis supported over a zygomatic implant. In maxillectomy cases, a zygomatic implant can be used to improve the retention of the obturator prosthesis, as the loss of alveolar bone makes it impossible to use conventional endosseous implants. Although zygomatic implants are reported to have high success rates, they are not free of complication. We hereby present a rare complication associated with the placement of a zygomatic implant in a patient with COVID-19-associated mucormycosis who underwent operation. This rare complication has never been reported before. This case report also highlights on the management of complications involving displacement of a zygomatic implant in the infratemporal region.
Subject(s)
COVID-19 , Mucormycosis , Zygoma , Humans , COVID-19/complications , Zygoma/surgery , Mucormycosis/surgery , Male , Dental Implants , Middle Aged , Maxilla/surgery , Dental Implantation, EndosseousABSTRACT
BACKGROUND: Brain abscesses caused by sinonasal infections have become more common during the coronavirus pandemic, particularly due to the increase in sinonasal mucormycosis. This study aimed to evaluate the efficacy and safety of endoscopic endonasal brain abscess drainage as a therapeutic technique for these cases. METHODS: Clinical outcomes and retrospective evaluations were performed in patients who underwent endoscopic endonasal brain abscess drainage between May 2019 and August 2022. A total of 7 patients diagnosed with 9 brain abscesses caused by sinonasal infections were included in the study. The main outcome of this study was to evaluate the success and safety of this technique. RESULTS: The average age of the patients was 40.71 ± 14.17 years. The most common symptom observed in these patients was nasal discharge, and the frontal lobe was the most common site of abscess. Notably, the majority of cases were associated with COVID-19. CONCLUSIONS: Based on the results of this study, endoscopic endonasal brain abscess drainage is considered a viable treatment option for skull base brain abscesses caused by sinonasal infections. Further research in this field can help establish this technique as a mainstay approach for managing brain abscesses at the skull base.
Subject(s)
Brain Abscess , COVID-19 , Drainage , Humans , Brain Abscess/surgery , Brain Abscess/diagnostic imaging , Brain Abscess/etiology , Male , Female , Adult , Middle Aged , Retrospective Studies , COVID-19/complications , Drainage/methods , Neuroendoscopy/methods , Treatment Outcome , Young Adult , Mucormycosis/surgerySubject(s)
Drainage , Lung Abscess , Mucormycosis , Humans , Drainage/methods , Lung Abscess/surgery , Lung Abscess/microbiology , Lung Abscess/diagnostic imaging , Mucormycosis/surgery , Male , Child , Mucor , FemaleABSTRACT
Restoring the maxillary resection defect involving the alveolar process, the hard and soft palate and the paranasal sinuses in terms of phonetics, mastication and deglutition is more challenging, especially with young patients with aesthetic concerns.This case report describes the prosthodontic rehabilitation of a young patient with a unilateral subtotal maxillectomy due to post-COVID-19 mucormycosis. A patient-specific subperiosteal implant was planned to rehabilitate the patient's bony defect. Using postsurgical CT, a customised subperiosteal titanium framework was fabricated by the direct metal laser sintering method using grade IV titanium alloy. The fabricated framework was implanted over the patient's zygomatic anatomic contour. Three months later, the patient-specific implant was unveiled to the oral cavity, an open-tray impression was made and the fixed implant prosthesis was fabricated.This case report opens a new realm of rehabilitation for severely compromised maxillary bony defects and impaired oral functioning with no other viable conventional reconstruction options.
Subject(s)
COVID-19 , Dental Implants , Mucormycosis , Humans , Mucormycosis/surgery , Prosthodontics , Titanium , Alveolar ProcessABSTRACT
A 55-year-old woman with a past medical history of visceral myopathy with multiple resultant abdominal surgeries, colectomy caused by severe pseudo-obstruction, and end-stage renal disease on hemodialysis presented with complaints of nausea, abdominal distention, vomiting, and diarrhea for five days. Small-bowel obstruction was identified on CT. She subsequently developed acute gastrointestinal bleeding, anemia, and hemodynamic instability. Extensive gastric ulceration with frank hemorrhage prompted urgent subtotal gastrectomy with multiple intraoperative findings, including a necrotic distal duodenum. Surgical pathology showed invasive fungal infection of the duodenum with perforation, morphologically compatible with invasive mucormycosis. The patient was started on intravenous liposomal amphotericin B, but despite best efforts, the patient ultimately succumbed to this invasive fungal infection in addition to sepsis and multi-organ failure.
Subject(s)
Intestinal Pseudo-Obstruction , Invasive Fungal Infections , Mucormycosis , Female , Humans , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/surgery , Duodenum , Necrosis/diagnosisABSTRACT
Mucormycosis is a rare and serious fungal infection, occurring mainly in immunocompromised, diabetic, polytrauma or burn patients. Current standard treatments include iterative carcinological surgical trimming, systemic treatment with liposomal amphotericin B and second-line Posaconazole or Isavuconazole. We report the case of a 37-year-old female patient with no previous medical history who developed a disseminated mucormycosis, with an estimated 25 % loss of skin substance and major decay of the chest wall. In addition to standard treatment, local instillations of amphotericin B using the VAC Veraflow® system were performed. We believe that local instillations of amphotericin B by VAC could improve the functional prognosis of patients with skin involvement.
Subject(s)
Amphotericin B , Mucormycosis , Female , Humans , Adult , Amphotericin B/therapeutic use , Mucormycosis/drug therapy , Mucormycosis/microbiology , Mucormycosis/surgery , Antifungal Agents/therapeutic use , SkinABSTRACT
PURPOSE: There has been a sudden increase in the number of rhino-orbital mucormycosis cases, primarily affecting patients recovering from COVID-19 infection. The local health authorities have declared the current situation an epidemic. In this study, we assess the role of exenteration in preventing disease progression and improving survival in patients with rhino-orbital mucormycosis. METHODS: The patients undergoing exenteration were grouped into the exenteration arm and those denying exenteration were grouped into the nonexenteration arm. The patients were followed at 1 month and 3 months. The 6-month survival data were collected telephonically. Continuous data were presented as Mean ± SD/Median (IQR) depending on the normality distribution of data, whereas the frequency with percentages was used to present the categorical variables. Kaplan-Meier survival curves were created to estimate the difference in survival of patients with exenteration in rhino-orbital mucormycosis versus those without exenteration. RESULTS: A total of 14 patients were recruited for our study based on the inclusion and exclusion criteria. All the patients were qualified for exenteration; however, only eight patients underwent exenteration and six patients did not consent to exenteration. At the end of 3 months in the exenteration group, four (50%) patients died. Two patients died within a week of exenteration, whereas two patients died after 2 weeks of exenteration. The deaths in the first week were attributed to septic shock and the deaths happening beyond 2 weeks were attributed to severe meningitis. The Kaplan-Meier survival analysis showed the cumulative probability of being alive at 1 month in the exenteration arm to be 85%, and it decreased to 67% by 53 days and subsequently remained stable until the end of 3 months. CONCLUSION: The Kaplan-Meier survival analysis did not show a survival benefit of exenteration at 3 months and 6 months in COVID-associated rhino-orbital mucormycosis.
Subject(s)
COVID-19 , Eye Diseases , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , Humans , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/surgery , Orbital Diseases/diagnosis , Orbital Diseases/surgery , Orbital Diseases/drug therapy , Eye Infections, Fungal/drug therapy , COVID-19/complications , Antifungal Agents/therapeutic useABSTRACT
La mucormicosis, es una patología de baja preva- lencia, rápidamente progresiva y de alta mortalidad que engloba un amplio espectro de infecciones del tipo opor- tunistas, causada por hongos de la familia Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunninghamellaceae, Syncephalastraceae y Radiomycetaeae. Actualmente es la tercera causa de infección fúngica invasiva, posterior a la candidiasis y aspergilosos, siendo su presentación clínica más frecuente la rinocerebral de origen paranasal, cuyo síntoma característico es la rinosinusitis aguda bacteriana con proyección a los dientes antrales, de rápido avance y fatalidad. En esta revisión se emplearon resultados extraídos ma- nualmente de artículos indexados en las bases de datos MED- LINE y EBSCO a raíz de la búsqueda de los términos mu- cormycosis, oral surgery y patient care management con el objetivo de entregar una visión actualizada de la literatura, respecto al diagnóstico y tratamiento de la mucormicosis de cabeza y cuello (AU)
Mucormycosis is a low-prevalence, rapidly progres- sive and high-mortality pathology that encompasses a wide spectrum of opportunistic infections caused by fungi of the Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunningha- mellaceae, Syncephalastraceae, and Radiomycetaeae. It is currently the third cause of invasive fungal infection, after candidiasis and aspergillosis, with its most frequent clinical presentation being rhinocerebral of paranasal origin, whose characteristic symptom is acute bacterial rhinosinusitis with projection to the antral teeth, with rapid progression and fatality. In this review, manually extracted results from articles indexed in the MEDLINE and EBSCO databases were used following the search for the terms mucormycosis, oral sur- gery and patient care management with the aim of providing an updated view of the literature regarding the diagnosis and treatment of mucormycosis of the head and neck
Subject(s)
Humans , Mucormycosis/surgery , Mucormycosis/diagnosis , Mucormycosis/therapy , Signs and Symptoms , Biopsy/methods , Risk Factors , Databases, Bibliographic , Debridement/methods , Head and Neck Neoplasms , Anti-Bacterial Agents/therapeutic use , Mucormycosis/microbiology , Mucormycosis/epidemiology , Antifungal Agents/therapeutic useSubject(s)
Lung Diseases, Fungal , Mucormycosis , Humans , Lung , Lung Diseases, Fungal/diagnosis , Mucormycosis/diagnosis , Mucormycosis/surgery , Female , Middle AgedABSTRACT
The incidence of mucormycosis showed a sharp rise during the COVID-19 pandemic in vulnerable populations like people with diabetes. Here, we report a case of mucormycosis of the frontal and ethmoid sinuses in a man in his mid-50s with a background of diabetes mellitus and COVID-19 infection requiring steroids and oxygen support. The infection had remained persistent despite initial debridement by functional endoscopic sinus surgery of the anterior frontal sinus wall and re-exploration, followed by debridement using the brow incision. The patient had received an entire course of systemic antifungal therapy during the postoperative period. A bifrontal craniotomy, excision of the supraorbital ridge and complete removal of bilateral frontal sinuses managed the persistent fungal infection. The defect was reconstructed with a custom-made three-dimensional-printed MRI-compatible titanium cranioplasty mesh. The patient had no signs of infection on the 9-month follow-up.
Subject(s)
COVID-19 , Mucormycosis , Plastic Surgery Procedures , Male , Humans , Mucormycosis/surgery , Pandemics , SkullABSTRACT
COVID-19, caused by SARS-CoV-2, has been linked to various bacterial and fungal infections. The incidence of mucormycosis has notably increased in individuals with COVID-19, with many cases reported globally, especially in India. The risk factors for developing mucormycosis include uncontrolled diabetes and use of immunosuppressants such as corticosteroids. We report a case of acute invasive fungal rhino-sinusitis (mucormycosis) in a 42 year old patient with no history of diabetes or steroid therapy but recently diagnosed with COVID-19. The patient presented with facial swelling, loose teeth, and imaging findings consistent with mucormycosis. The history, examination, and laboratory investigations were sufficient to exclude other causes of immunocompromised status in the patient. The diagnosis was confirmed through KOH staining of excised tissue, which tested positive for mucor. The patient underwent systemic antifungal therapy and Functional Endoscopic Sinus surgery (FESS) associated with a bilateral maxillectomy to remove the affected tissue. These interventions were successful, and the patient experienced a positive clinical response. This case report details an uncommon presentation of post COVID-19 acute invasive fungal rhino-sinusitis in a patient without typical risk factors for the infection. Therefore, clinicians should have a high index of suspicion for mucormycosis in patients with a recent history of COVID-19 infection, especially those with symptoms such as facial swelling or tooth loss. Prompt detection and management of mucormycosis are critical for improving patient outcomes. However, delays in diagnosis and treatment can lead to significant morbidity and mortality. (AU)
La COVID-19, causada por el virus SARS-CoV-2, se ha relacionado con varias infecciones bacterianas y fúngicas. La incidencia de mucormicosis ha aumentado notablemente en individuos con COVID-19, habiéndose reportado muchos casos a nivel mundial, especialmente en la India. Los factores de riesgo para desarrollar mucormicosis incluyen diabetes descontrolada y el uso de inmunosupresores como los corticosteroides. Presentamos un caso de rinosinusitis fúngica invasiva aguda (mucormicosis) en un paciente de 42 años sin antecedentes de diabetes ni terapia con esteroides, pero recientemente diagnosticado con COVID-19. El paciente presentaba hinchazón facial, movilidad dental y hallazgos de imágenes consistentes con mucormicosis. La historia clínica, el examen físico y las investigaciones de laboratorio fueron suficientes para descartar otras causas de inmunocompromiso en el paciente. El diagnóstico se confirmó mediante tinción con KOH del tejido extirpado, que resultó positiva para mucor. El paciente recibió terapia antifúngica sistémica y se sometió a una cirugía endoscópica funcional de senos paranasales (FESS) junto con una maxilectomía bilateral para extirpar el tejido afectado. Estas intervenciones fueron exitosas y el paciente experimentó una respuesta clínica positiva.Este informe de caso detalla una presentación poco común de rinosinusitis fúngica invasiva aguda post-COVID-19 en un paciente sin factores de riesgo típicos para la infección. Por lo tanto, los médicos deben tener un alto índice de sospecha de mucormicosis en pacientes con antecedentes recientes de infección por COVID-19, especialmente aquellos con síntomas como hinchazón facial o pérdida de dientes. La detección y el manejo oportunos de la mucormicosis son fundamentales para mejorar los resultados del paciente. Sin embargo, los retrasos en el diagnóstico y el tratamiento pueden provocar una morbilidad y mortalidad significativas. (AU)
Subject(s)
Humans , Male , Adult , Pandemics , Coronavirus Infections/epidemiology , Mucormycosis/surgery , Mucormycosis/therapy , Severe acute respiratory syndrome-related coronavirus , Antifungal Agents , EndoscopyABSTRACT
The rehabilitation of facial deformities is a challenging endeavour that necessitates customising the procedure for each patient. Significant physical and psychological impacts might arise as a result of the deformity in the orofacial region. Post-COVID rhino-orbital mucormycosis has led to rise in extraoral and intraoral defects since 2020. To avoid further surgery, an economical maxillofacial prosthesis is an excellent choice as it is aesthetic, durable, long-lasting and retentive. This case report describes the prosthetic rehabilitation of the patient with post-COVID mucormycosis maxillectomy and orbital exenteration using a magnet-retained closed bulb hollow acrylic obturator and room-temperature vulcanising silicone orbital prosthesis. To enhance retention, a spectacle and medical-grade adhesive were also used.
Subject(s)
COVID-19 , Mucormycosis , Humans , Mucormycosis/diagnosis , Mucormycosis/etiology , Mucormycosis/surgery , Magnets , Nigeria , Prostheses and ImplantsABSTRACT
BACKGROUND: Osteonecrosis in mucormycosis is a rare phenomenon and has been reported usually following trauma or in immunocompromised individuals. Osteonecrosis of skull as a complication of mucormycosis is a rare presentation, which makes the study ever so rare and interesting. METHODS: Within 6 months, a total of 114 patients presented with mucormycosis as COVID-19 sequel, 60 of whom underwent form of endoscopic sinus debridement. Six of these 60 patients presented with frontal bone osteonecrosis and were included in the study. All 6 patients presented within a time period of 2-4 months' post FESS. RESULTS: One of the 6 patients succumbed to her illness. Another patient presented with local recurrence after 3 months, for which she underwent resurgery and debridement. The other 4 patients showed gradual recovery and are without symptoms or radiologic progression at 6-month follow-up. CONCLUSIONS: Osteonecrosis in mucormycosis is a rare phenomenon, and the 2 entities have rarely been reported together. The disease usually limits itself to the frontal bone only, and pathogenesis for spread is due to a vicious cycle of infection and ischemia. Prompt diagnosis via imaging, aggressive surgical debridement with a good antifungal cover, good patient compliance, and regular follow-up form the mainstay of treatment.
Subject(s)
COVID-19 , Mucormycosis , Osteonecrosis , Humans , Female , Mucormycosis/complications , Mucormycosis/surgery , Mucormycosis/diagnosis , Frontal Bone , Pandemics , COVID-19/complications , Antifungal Agents/therapeutic use , Osteonecrosis/diagnostic imaging , Osteonecrosis/etiology , Osteonecrosis/surgeryABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has posed another serious threat, mucormycosis infection, affecting the maxilla and orbitocerebral region. This condition has not spared world population from its merciless claws. This article addresses the challenges faced by the maxillofacial surgeons in setting the protocols from preoperative diagnosis, surgical management to postoperative care, including short-term and long-term rehabilitation. To manage this relentlessly progressing condition, a multispecialty team approach is to be activated in diagnosing, managing, and rehabilitating the patients. PURPOSE: The purpose of this clinical study is to document and analyze the clinical and demographic data, presentation of the lesion, the diagnostic methods followed for early clinical detection, and management of post COVID-19 midface mucormycosis. The article also discusses postoperative medical management and prosthetic rehabilitation. RESULTS: Most of the mucormycosis cases reporting to our center were treated and recovered patients of Severe Acute Respiratory Syndrome Coronavirus 2 infection. Thirty-four (n=34) case were operated for post COVID-19 midface mucormycosis between October 2020 and December 2021. Male to Female ratio is 1:42. The average age of the patients was 57.5 years. Maximum patients were in fifth and sixth decade of life. Maxilla was the involved bone. Treatment was primarily surgical debridement to extended or radical maxillectomy. All patients were treated with Liposomal Amphotericin B and tab posaconazole for 3 to 4 weeks depending upon the age, weight, and physiological state of the patients to attain an optimal cumulative load. Three patients succumbed to illness postoperatively (n=3, 1.02%). Average duration of hospital stay was 47 days. The average review period was 5.1 months.
Subject(s)
COVID-19 , Mucormycosis , Humans , Female , Male , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/surgery , Face , Postoperative Care , Antifungal Agents/therapeutic useABSTRACT
OBJECTIVE: Mucormycosis is a rapidly progressive and fulminant fungal infection mainly affecting the nose and paranasal sinuses and often requiring aggressive surgical debridement, which commonly includes inferior maxillectomy. Conventional inferior maxillectomy involves removal of the bony hard palate and its mucoperiosteum. This can lead to formation of an oroantral fistula and thereby increase the morbidity in these patients leading to prolonged rehabilitation. Subperiosteal inferior maxillectomy involves sparing of the uninvolved mucoperiosteum of the hard palate. This flap is used for closure of the oroantral fistula, which preserves the functional capabilities of the patient, such as speech, mastication and deglutination. METHOD: This case series describes the experience of using the technique of mucosa-preserving subperiosteal inferior maxillectomy in five patients with mucormycosis. RESULTS: With the technique used in this study, complete oronasal separation was achieved in all six patients. The overall surgery time was also decreased when compared with free tissue transfer. Patients also did not have to bear the weight of prosthesis. CONCLUSION: Mucoperiosteal palatal flap-preserving subperiosteal inferior maxillectomy is an excellent approach for all patients with mucormycosis and healthy palatal mucosa.
Subject(s)
Mucormycosis , Paranasal Sinuses , Humans , Mucormycosis/surgery , Oroantral Fistula , Palate, Hard/surgery , Surgical FlapsABSTRACT
Apophysomyces species are an emerging cause of mucormycosis in several regions of the world, primarily affecting immunocompetent individuals. The present study addresses the global epidemiology, clinical presentation, management and outcome of mucormycosis caused by Apophysomyces spp. The study included patients diagnosed with Apophysomyces infection at our hospital between March 2019 and August 2020. In addition, cases published in PubMed and Google Scholar from inception to July 2022 were systematically searched and analysed. Only proven and probable cases that meet the eligibility criteria were included. The Indian cases were compared with those from other countries, and the results were analysed by descriptive statistics. In total, six cases of mucormycosis due to Apophysomyces spp. were diagnosed at our hospital, with additional 250 cases identified through literature search. The main underlying diseases were diabetes mellitus (24%), malignancy (3.2%) and chronic kidney disease (2.8%). The major predisposing factor was trauma (55.6%). Necrotizing fasciitis was the most common (63.2%) clinical presentation. Healthcare-associated mucormycosis accounted for 10.4% of the cases. Globally, A. elegans was the most common species (48.8%), whereas A. variabilis was predominant (86.2%) in India. Surgery was performed in 83.5% of patients. Among those treated with antifungal agents, 98% received amphotericin B and 8.1% received posaconazole. Inappropriate antifungal usage was observed in 12.7%. The overall mortality was 42.3%. A combined medical and surgical management was associated with higher survival. Our study highlights the knowledge gap among physicians regarding this infection. A timely diagnosis and aggressive management can improve the outcomes in such cases.
Subject(s)
Mucorales , Mucormycosis , Humans , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , India/epidemiology , Mucorales/isolation & purification , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Mucormycosis/microbiology , Mucormycosis/surgery , Tertiary Care Centers , Global Health/statistics & numerical data , Treatment OutcomeABSTRACT
PURPOSE: To compare the efficacy of 0.1 % w/w Liposomal Amphotericin-B gel with 10 % w/w Povidone-Iodine and saline nasal douching in preventing revision surgery in patients with CAM. STUDY DESIGN: Multi-arm, parallel randomized control trial. STUDY SETTING: The trial was conducted in the Department of ENT, All India Institute of Medical Sciences (AIIMS) Bhubaneswar. METHODS: Participants: Microbiologically and histologically proven cases of mucormycosis who underwent surgical debridement were included in the study. INTERVENTIONS: Postoperatively, patients were randomized into three groups based on the type of topical intervention received, in the form of Lipid-based Amphotericin B gel, povidoneiodine ointment or saline nasal douching. OUTCOME: Requirement of revision surgery in postoperative cases of CAM. RANDOMIZATION: Participants were allotted to one of the three arms by block randomization. BLINDING: Single-blinded trial. RESULTS: Numbers randomized: 15 participants were randomized to each group. Recruitment: Completed recruiting. Numbers analyzed: 15 participants were analyzed in each group. OUTCOMES: Control arm's risk of revision surgery was 4.50 (95 % CI: 1.16-17.44) times than Lipid-based Amphotericin B gel arm and 1.50 (95 % CI: 0.71-3.16) times that of the Povidone- Iodine arm. The difference was statistically significant (p = 0.02) for Amphotericin but not for Povidone-Iodine. CONCLUSIONS: Topical Amphotericin-B gel application in the postoperative cavity can decrease the need for revision surgery and help in early recovery. TRIAL REGISTRATION: CTRI/2021/10/037257. Clinical Trials Registry of India.
Subject(s)
COVID-19 , Mucormycosis , Humans , Amphotericin B , SARS-CoV-2 , Povidone-Iodine , Mucormycosis/drug therapy , Mucormycosis/surgery , Lipids , Treatment OutcomeABSTRACT
OBJECTIVES: This study aims at reporting the surgical outcomes of COVID associated pulmonary mucormycosis with special emphasis on surgical mortality. METHODS: This prospective observational study was conducted in a dedicated thoracic surgical unit in Gurugram, India over 18 months. An analysis of demography, peri-operative variables were carried out. Various parameters were analysed to assess the factors affecting mortality. RESULTS: Total of 44 patients with diagnosis of CAPM were managed during the study period. All were started on anti-fungal therapy. However, 33 patients (75%) were operated whereas rest 11 (25%) were not considered suitable for surgery. In the surgical cohort (n = 33), there were 20 males (60.6%) and 13 females (39.4%), with a mean age of 54.8 years (range, 33-72 years). The mean duration of the symptoms was 1.1 weeks. Non-anatomical wedge resection of lobe(s) was performed in 5 patients (15.1%), lobectomy/bi-lobectomy was required in 26 patients (78.9%) and left pneumonectomy in 2 patients (6%). There were 5 peri-operative deaths (15.1%), all due to fungal sepsis. ECOG scale > 2 (P ≤ 0.001), higher Charlson Comorbidity Index score > 2 (P = 0.04) and pneumonectomy (P = 0.02) were the predictors of mortality. On comparison with NCPM, there was no difference in the incidence of post-operative complications (P = 0.50) and the post-operative mortality (P = 0.69). CONCLUSION: Aggressive surgical resection with clear margins should be offered in CAPM, whenever feasible. Surgery for CAPM was not associated with higher post-operative complications including mortality compared to Non-COVID Pulmonary Mucormycosis.