The Covid-19 epidemic has been noted to be associated with an increase in another type of infection—rhinoorbitocerebral mucormycosis. Rhinoorbitocerebral mucormycosis is a dangerous infection of the nose which causes destruction and disfigurement and spreads to the eye, and from the eye to the brain.
Infection with mucormycosis usually occurs in patients who have compromised immunity due to some other underlying illness. It is very unusual for the infection to occur in someone who is otherwise healthy and has normal immunity. In our practice previously, such infection with mucormycosis was commonly noted in patients with uncontrolled diabetes, and sometimes in patients receiving immune-suppressing medicines or steroids. In recent months, however, the commonest underlying condition which has been noted to be associated with a mucormycosis infection is a Covid-19 infection.
The mucormycosis infection starts in the nose. It causes a rapid gangrene of the mucosa of the nose and may also cause darkening and gangrene of the overlying skin and the hard palate. It can spread to the eyes and from the eyes to the brain. The spread is generally along the blood vessels as the fungus which causes the infection is known to have a specific predilection for the blood vessel lining and spreads along it.
An increase in the number of patients with such an infection has been noted since April when the Covid-19 epidemic was first manifesting. Since then, as the number of Covid-19 patients has increased, a proportionate increase has been noted in patients with mucormycosis infection. In many instances, the Covid-19 infection has been asymptomatic and the first illness noted by the patient was the mucormycosis infection in the nose and eye.
Covid-19 can be complicated by many secondary events which predispose to a severe infection such as mucormycosis. Covid-19 has been noted to cause wide fluctuations in blood sugar levels and may precipitate in uncontrolled diabetes. It may also lead to an increased tendency of clot formation in the blood vessels of the brain and eyes. It is also associated with a decrease in the lymphocyte count and may compromise cell mediated immunity. All these mechanisms seem to be contributing to immune compromise and leading to the increasing incidence of mucormycosis in these patients.
The infection can be very serious. It may lead to blindness and disfigurement and may even be life-threatening.
We have had sufficient experience in dealing with this illness in the past many years, but treating the infection in the presence of active Covid-19 brings new challenges. Patients need immediate hospitalisation, treatment with intravenous antifungal drugs, and often immediate surgery to remove the infection and necrosis so as to clear the fungus and prevent its spread to other areas. Only immediate and active treatment can lead to control of the infection and limit its serious effects.
The writer is HoD, ENT, AIIMS.