Facial pain, facial swelling, and vision loss due to COVID-19 require clinical evaluation and surgery, followed by radical antifungal treatment and proper follow-up care, says Rupa Vedantam, professor of ENT, CMC, Vellore.
She spoke as a distinguished speaker at a virtual conference on “Diagnosing and Management of Mucormycosis” at the 75th Medical Education Update (CME) on COVID-19 organized by Andhra Medical College (AMC) on Sunday.
Mucormycosis (black fungus) requires a multidisciplinary approach with specialists from different disciplines such as ENT medicine, anesthesia, diabetology, pathology, radiology, nephrology, prosthetics, ophthalmology and neurosurgery. Nasal endoscopy and fungal culture will need to be performed, and a CT scan of the patient will need to be performed.
Dr. Rupa said that the moment mucormycosis is suspected, antifungal treatment should be started without waiting for reviews. Early treatment would help avoid orbital exenteration, as periorbital debridement was sufficient in most cases. Liposomal amphotericin B, which has negligible kidney toxicity, should be preferred over amphotericin B, she said.
Correct protocols
The challenges in treating patients include high costs for evaluation and therapy, poor availability of standard laboratory services for mycology and pathology. She stressed the need to develop appropriate protocols for the appropriate use of steroids and proper monitoring of blood sugar levels in COVID-19 patients before the third wave outbreak, as these causes were believed to be causing the flare-up in mucormycosis during the second wave have wave.
Rajsekhar Vedantam, Professor of Neurosurgery, CMC, Vellore, another distinguished speaker, gave a talk on “Neurosurgical Intervention in Mucormycosis”. He said the role of neurosurgeons in the end result of mucormycosis patients is as small as the debridement of infected brain tissue.
Previously, Vinod Kumar V, Project Leader of the AP Health Systems Strengthening Project (APHSSP), spoke in his opening speech about his collaboration with Andhra Medical College.
PV Sudhakar, Principal, AMC who was the moderator of the CME, said the webinars started during the first wave of COVID-19. He said that of the 186 mucormycosis patients treated at KGH, a majority had a previous COVID-19 infection and only two patients had no COVID-19.
MV Vijaysekhar, neurosurgeon, AMC / KGH, said nine patients had surgery for intracranial elongation of mucormycosis. In two cases, minimally invasive procedures were used.