Abstract

Introduction

Mucormycosis is an angioinvasive disease caused by fungi of the order Mucorales like  Rhizopus, Mucor, Rhizomucor, Cunninghamella and Absidi. The prevalence of mucormycosis in India is approximately 0.14 cases per 1000 population, about 80 times the prevalence in developed countries⁽³⁾. Mucormycosis is a potentially fatal opportunistic infection that can manifest in many different clinical forms, including a rhinocerebral form, in the pulmonary system, central nervous system, gastrointestinal system, and other parts of the body. Rhinocerebral mucormycosis is subdivided into 3 groups: rhinomaxillary, rhino-orbital, and rhino-orbito-cerebral mucormycosis⁽⁵⁾. Extensive forms of the disease include ophthalmia and cranial nerve involvement⁽⁶⁾. Mucormycosis is more often seen in immunocompromised individuals, and complications of orbital and cerebral involvement are likely in diabetic ketoacidosis and with concomitant use of steroids. The most common risk factor associated with mucormycosis is diabetes mellitus in India⁽⁴⁾. Hence, early diagnosis of this potentially life-threatening disease and prompt treatment is of prime importance in reducing the mortality rate.

Recently, several cases of mucormycosis in people with COVID-19 have been increasingly reported world-wide, in particular from India. We, hereby, report 4 cases of clinically diagnosed orbital mucormycosis with concurrent COVID‑19 illness at our institute over the last 2 months (May and June 2021). All of these patients were admitted as, RT-PCR positive cases of COVID-19 and were being treated for the same in our hospital. Potassium hydroxide (KOH) wet mount and fungal culture/sensitivity were done from biopsy obtained during debridement or from nasal swab obtained during diagnostic nasal endoscopy. Microbiological diagnosis of mucormycosis was proven in three patients. All patients in our series were known diabetics and were receiving intravenous steroids, broad spectrum antibiotics and remedesivir as a part of treatment of COVID-19. All patients in our series had received intravenous dexamethasone for COVID‑19 disease as per The National Institute of Health recommendations⁽¹⁾. The use of steroids, monoclonal antibodies, and broad‑spectrum antibiotics for the management of COVID‑19 illness can increase the chances of new‑onset fungal infection or exacerbate a preexisting one.⁽²⁾