CLINICAL PARADIGMS IN DIAGNOSIS OF MUCORMYCOSIS USING NASAL ENDOSCOPY IN COVID AND POST COVID PATIENTS
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 3, Pages 12153-12163
AbstractBackground: 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
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