Online ISSN: 2515-8260

Keywords : Mucormycosis


Beladakere Channaiah Vijayalakshmi, Anand Shalini, Thuraganur KapaniGowda Shashikala, Honnavara Govindaiah Manjunath, Govinda Rao Dinesh, Nagaraj Kokila, Anand Poornima

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1815-1822

Background and objectives:  During the second wave of corona virus pandemic, we saw an increase in the case reports of rhino-orbital mucormycosis in patients with coronavirus disease (COVID -19) or in patients who had recovered from COVID -19 infection. We evaluated the patient characteristics and predisposing factors in these patients having mucormycosis.
Materials and method: This retrospective observational study included 84 patients with mucormycosis diagnosed during their course of COVID-19 illness between May 2021 to July 2021.Data regarding demography, underlying medical condition, extent of involvement of mucormycosis, COVID-19 status and treatment taken during COVID-19 illness were collected.
Results: Eighty-four patients presented with mucormycosis out of which 59 patients were males and 25 females. Majority were in the age group of 40-60 years (71.4%). Rhino-orbital was the most common form of mucormycosis. Intracranial spread was noted in 16 patients. Hyperglycemia at presentation (either pre-existing or new onset diabetes mellitus) was the single most important risk factor observed in majority of these cases (80 patients / 95.23%) followed by history of Corticosteroid use in 68 patients (80.95%) and oxygen administration during their course of treatment for COVID-19 illness in 64 patients. (76.19%)
Conclusion:The association between coronavirus and mucormycosis must be given serious consideration. Uncontrolled diabetes and over-zealous use of corticosteroids are the two most important factors aggravating the illness. All efforts must be made to maintain optimal glucose levels in COVID-19 patients and use corticosteroids judiciously.


Poonam Khairnar, Mahesh Thikekar, Rajesh Kar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 12153-12163

Background: Nasal endoscopy is a procedure to examine the nasal and paranasal sinus passages with 0 degree nasal endoscopes. Mucormycosis is an aggressive, life-threatening invasive fungal infection affecting paranasal sinuses, orbits and brain. Early diagnosis of mucormycosis  is possible with   diagnostic nasal endoscopy (DNE) in  covid and post covid  high risk patients.
Objective: To substantiate the need of nasal endoscopy in high risk covid and post covid patients.
Materials and Methods: Covid (48) and Post covid (64) patients (both male and female) underwent diagnostic nasal endoscopy at tertiary care hospital during period of Jan 2021 to Dec 2021. All study subjects were screened with nasal endoscopy in ENT OPD. On nasal endoscopy the target area showed eschar or blackish discolouration of turbinates and septal perforation. MRI (PNS+ORBITS+BRAIN) with contrast was carried out in suspected patients to know the extent of invasive fungal infection. All symptomatic patients were screened by opthalmologists to see extent of invasion.
Results-Out of 112 patients, 70 patients were asymptomatic while only 42 patients were symptomatic for fungal invasion.  Out of 70 asymptomatic patients, 52 patients   were positive for fungal infection. Chronic diabetes mellitus and newly diagnosed diabetes mellitus (95 patients) was common co-morbidity associated with fungal positive HPR sampling.(71 patients).
Conclusion -Follow up of the high risk post covid patients, for sequeale with diagnostic nasal endoscopy should be mandatory as majority of our patients are asymptomatic.  Patient may present with atypical symptoms like earache, nasal polyposis so high degree of suspicion is essential.    Besides mucormycosis, coinfection with aspergillus also observed in our study. So reporting of such cases is also important. A coordinated effort from a multidisciplinary team including otorhinolaryngology, ophthalmology, neurosurgery, critical care, microbiology, and pathology department is also important. A delay of initiating treatment of mucormycosis may lead to  gross rise in morbidity and mortality rate

To evaluate the mucormycosis cases in post Covid-19 patients

Dr. Snehanshu Shukla, Dr. Ranvijay Singh, Dr. Gaurav Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 134-138

Aim: To evaluate the mucormycosis cases in post Covid-19 patients.
Methods: This cross-sectional observational study was carried out in the Department of
Microbiology. Basic microbiological methods such as gram stain and KOH smear were
used for the detection of MC in the received clinical specimen and morphology was seen
in the microscope. Patients admitted in our hospital with a history of fever, cough, body
ache and shortness of breath for 4-5 days with have positive report of nasopharyngeal/
oropharyngeal swab for covid19 RT-PCR were included in the present study.
Results: Age, sex and other demography details were collected before sample collection,
the average age of the participants was 60.4 ± 7.5 years and the majority of participants
were male 75%. Although, 45% participants belong to below 50 year age and 55% of
participant belongs to above 50 year age. Out of n=50 specimens, total 9 specimen found
positive for fungal smear i.e. n=6 sputum, n=3 nasal swabs and n=0 BAL specimens.
Conclusions: The present study concluded that the cases of life threatening MC increase
day by day in central India as post complication of covid-19 disease.

Management of Post COVID Mucormycosis –Maxillectomy

M. Meena Kumari, Sowjanya Kumari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10378-10386

Background:Mucormycosis has been increasingly described in patients with covid 19
2nd wave (delta variant) which is a highly contagious disease caused by SARS-COV-2 is
the leading cause of global pandemic. AIM AND OBJECTIVES: To evaluate etiology,
indications, management options and complications in patients managed with
endoscopic and external maxillectomy after mucormycosis, to evaluate the incidence
and distribution of cases who had extensive mucormycosis and to evaluate the outcome
of the management options.
Materials and Methods: This is a prospective study done in 30 cases at a tertiary care
centre.All the patients were subjected to detailed history taking, clinical
examination,endoscopic,radiological,pathological,microbiological investigations after
taking informed consent. Patients with age group(30yrs -70yrs) who presented with
ROM with extensive maxillary sinus involvement and destruction of different walls of
the maxillary sinus were managed with different types of maxillectomies.
Results: In this study, 30 cases of post covid rhinoorbital mucormycosis who presented
to our hospital were studied,among male 24(80%) & females6 (20%).12 patients (40%)
were in 5th to 6th decade and 9 patients (30%) in 4th to 5th decade.Main presenting
features were unilateral cheek pain,cheek swelling,nasal obstruction,loosening of teeth,
tooth ache, cheek numbness, headache,periorbital edema,visual disturbances being
present in 95% of the patients.5% presented with epistaxis,ptosis,diplopia alone.90%
patients were known case of diabetes milletus,10% are denovo diabetes.All the patients
were subjected to routine blood investigations, microbiological,
radiologicalinvestigations.(CT,MRI contrast- PNS,Orbit & Brain).Most commonly seen
in males 80%. 1 patient had to undergo orbital exenteration,3 patients underwent
palatal resection.
Conclusion: Debridement of sinuses is necessary in all cases of mucormycosis so that the
fungal reservoir could be removed and the antifungal therapy can reach the viable
areas. Therefore the management of mucormycosis is individualised to each patient
based on the extension of the disease and overall general conditon of the patient

A study on clinical presentation of rhino orbital cerebral mucormycosis associated with COVID-19 infection

Dr. Bomma Vijay Kumar, Dr Naresh Mogilicharla, Dr. Potlacheruvu Nagaraju, Dr. Moota Madhuri, Dr. A Shobhan Babu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1988-1997

Background and aims: During the second wave of coronavirus disease 2019 [covid-19] in India, there is a rapid surge of opportunistic fungal infections among covid-19 patients. Rhino-Orbito-Cerebral mucormycosis is the most common disease among these patients apart from pulmonary aspergillosis. The study aims to determine the clinical presentation, signs, and symptoms in patients with rhino-orbito-cerebral mucormycosis associated with coronavirus disease in the present scenario.
Methods: It is a retrospective observational study. The Clinical history of 100 patients from medical records with Rhino-Orbito-Cerebral mucormycosis associated with covid-19 during the months of May and June 2021 is collected and analyzed.
Results: In our study on 100 patients with mucormycosis infection 95 patients were diagnosed with covid-19 infection and 82 patients were diabetic. Among the diabetic group, 53 were chronic diabetic and 29 were detected denovo. The disease is seen most prominently in the people of the age group between 30-60yrs. Males are more affected. The urban population represented 67 percent. The chief complaints of the patients with mucormycosis related covid-19 are pain (88%), swelling/edema (79%), visual disturbance (51%), numbness over the face (47%), nasal discharge (45%). Clinical findings of the disease are, ptosis (52%), blurring/absent vision (51%), proptosis (41%), ophthalmoplegia (33%), discoloration over the face (26%) and necrosis of the soft tissues (8%).The percentage of people presented with mucormycosis between diagnosis of covid-19 infection and onset of symptoms of mucormycosis is observed to be 72% within two weeks and 89% within three weeks. Regarding the covid-19 symptoms, mild symptoms were seen in 59.9%, moderate symptoms in 29.4% and severe symptoms in 10.5% of patients. 76 patients were on corticosteroid therapy and 35 patients were oxygen-dependent.

Mucormycosis in COVID: A pandemic induced epidemic in World’s diabetic capital

Dr Fayaz A. Wani, Dr Ishan Tikoo, Dr Aashish Mahajan, Dr JB Singh, Dr Deepika Dewan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1051-1058

Background: Mucormycosis is a rare disease of immunocompromised adults largely
restricted to the diabetic community with uncontrolled hyperglycaemia. In the second
wave of Covid, in multiple cities over the Indian Peninsula, this much dreaded “black
fungus” has afflicted many individuals who suffered from covid or were recovering
from it.
Aim: To establish the risk factors, clinical presentation, diagnostic sensitivities,
radiological survey of different types of mucormycosis in SARS Cov 2 patients.
Methods: Seventeen patients with covid infection admitted in tertiary care hospital with
diagnosed mucormycosis between Nov 2020 to June 2021 via histopathological or
culture confirmation. This is a cross-sectional observational study where detailed
assessment of clinical profile, biochemical markers and sensitivities of diagnostic
procedures was done. The data then collected and was made into a master chart and
subjected to statistical analysis. Fischer exact test was used for statistical anaylsis.
Result:In total of 17 patients,mean blood glucose levels were compared at the onset of
symptoms of covid and mucormycosis werestatistically significant with (P=0.001). Out
of 17 patients, 11 were rhino-orbital mucormycosis, four had rhino-orbito-cerebral
mucormycosis and 2 had pulmonary mucormycosis.HbA1c >8 had significant
correlation(P=0.009) with rhino-orbital and rhino-orbito-cerebral mucormycosis
whilehigher total dosage of steroids was associated with pulmonary mucormycosis (P=
0.015. Sensitivity of culture was 64.7% in our study while histopathology was
considered gold standard.
Conclusion: Our study shows strong correlation between the long term as well as short
term glycaemic control with the onset of rhino-orbital mucormycosis while dosage and
duration of steroids with pulmonary mucormycosis.

A Comparative study of the clinical characteristics of the first and second waves of COVID-19 in a tertiary care centre of North India

Dr Vijay Kumar , Dr Divendu Bhushan , Dr Sushmita Supriya , Dr Pallavi Lohani Dr Avinash Aravind Ganapule , Dr. Anjani Kumar , Dr. (Prof.) Sanjay Pandey .

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2082-2094

Aims & Objectives : To compare the clinical characteristics/profiles of the patients in first and second waves of COVID-19 in India and correlate these characteristics with risk of in-hospital mortality.
Design: Observational analytical study with longitudinal follow-up. The clinico-epidemiological and laboratory profile of patients admitted in the second wave of COVID-19 will be noted at the time of admission, and they will be followed-up during their stay in the hospital to record their outcome status. Medical records will be used to record the data of COVID-19 patients admitted in the first wave.
Setting: A tertiary care centre in Bihar, India
Participants: All patients who are COVID-19 positive based on positive RT-PCR test of oropharyngeal or nasopharyngeal swab and admitted to AIIMS, Patna during the study period.
Outcome measures: The difference in clinic-epidemiological profile of patients admitted in AIIMS Patna during the first and second wave of COVID-19 and thus we attempted to discover the effects of multiple factors such as vaccination and mutant viruses on the profile of the 2nd wave. We could also correlate the outcome status of the patient with their clinic-epidemiological profile.
Results: Females were relatively more commonly affected in the second wave. Contact history was significantly higher in the second wave. Comorbidities and clinical features were mostly similar although generalized weakness and fatigue was more common in the second wave. ARDS and septic shock were less frequent in the second wave although overall mortality was slightly higher. Azithromycin, HCQ use was discontinued whereas pulse methylprednisolone started to be used frequently. Remdesevir and tocilizumab use was
European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 08, Issue 04, 2021
rationalized. HFNC and NIV were better utilized in the second wave. Mucormycosis outbreak complicated the second wave. Out of 42 individuals who were partly immunized (fourteen days after 1st dose to symptom onset), 28 patients survived.


Dr. G. NISHANTH; Dr. N. Anitha; Dr. N.Aravindha Babu; Dr. L. Malathi

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 1786-1791

Mucormycosis is a rare angio invasive infection mainly recognized in immunocompromised patients which occurs due to the fungi mucorales. This rare fungal infection can be classified into rhino-orbitocerebral, cutaneous, disseminated, gastrointestinal, and pulmonary types. Inspiote of aggressive treatment once detected or diagnosed overall increased mortality rate is reported. This review aims in providing with brief details regarding the Etiopathogenesis of Mucormycosis, fatality of rhinocerebral Mucormycosis along with recent advances in diagnostic and treatment methods