Our Surgical Experience with 300 Cases of Covid Associated Mucormycosis(CAM)

Authors : Dr. K. Shanti; Dr. K. Kishore; Dr. G. Siva Prasad; Dr. A. Dhivya

Volume/Issue : Volume 8 - 2023, Issue 1 - January

Google Scholar : https://bit.ly/3IIfn9N

Scribd : https://bit.ly/3XWOWpk

DOI : https://doi.org/10.5281/zenodo.7592787

The incidence of mucormycosis increased dramatically after the COVID-19 pandemic which was named CAM (covid associated mucormycosis). The number of published articles on mucormycosis increased from 74 in the year 2000 to 786 in the year 2022 [2]. It indicates the increasing disease burden. Mucormycosis prevalence in India is estimated to be 140 cases per million people, which is almost 80 times greater than the incidence in wealthy nations. Death was reported in 389/851 (46%) patients in a systemic review and meta-analysis of 851 case reports published in 2018. In May 2021, several Indian states declared mucormycosis a notifiable disease in response to the rise in COVID-19-associated mucormycosis [1]. Methods: For all the patients who are suspected to have mucormycosis, nasal scrapings were taken under endoscopic guidance and sent for KOH mount and culture. Regardless of the microbiological evidence, based on diagnostic nasal endoscopic findings alone we subjected all patients to MRI brain and PNS and Orbits multiplanar fat-suppressed images with and without contrast. A sum of 300 patients who are confirmed to have mucormycosis early or late in the course of treatment and for which who received surgical and medical management was included in the study. Results: All 300 patients received intravenous liposomal amphotericin B. 17 patients underwent limited surgical debridement; 137 patients underwent the modified denkers approach for surgical debridement; 146 cases underwent infrastructure maxillectomy. Among them, 18 cases (8%) needed revision surgical debridement within 1 year of follow-up. Only one patient died postoperatively out of 300 patients showing a mortality rate of 0.33% Conclusion: Early diagnosis of mucormycosis remains difficult and is a significant unmet need, creating a bottleneck in developing novel, efficient clinical interventions. Early surgical debridement along with antifungal helps in reducing mortality greatly.

Keywords : Immunosuppression, Liposomal Amphotericin-B, Mucormycosis, CAM.


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