Facial pain, facial swelling and loss of vision due to COVID-19 require clinical examination and surgical intervention followed by radical anti-fungal treatment and proper follow-up, says Rupa Vedantam, Professor of ENT, CMC, Vellore.
She was addressing a virtual conference as a distinguished speaker on ‘Diagnosis and management of mucormycosis’ at the 75th continuing medical education (CME) update on COVID-19, organised by Andhra Medical College (AMC) on Sunday.
Mucormycosis (black fungus) requires a multidisciplinary approach with specialists from various disciplines like otolaryrngology, anaesthesia, diabetology, pathology, radiology, nephrology, prosthodontics, ophthalmology and neurosurgery dealing with the case. A nasal endoscopy and fungal culture have to be done and a CT scan of the patient taken.
Dr. Rupa said that the moment mucormycosis was suspected anti-fungal treatment should be started without waiting for the test reports. Early treatment would help in avoiding orbital exenteration as in most cases periorbital debridement was enough. Liposomal Amphotericin B, which has negligible renal toxicity should be preferred over Amphotericin B, she said.
Proper protocols
The challenges in the treatment of patients, include high cost of evaluation and therapy, poor availability of standard laboratory services for mycology and pathology. She underlined the need to develop proper protocols for appropriate use of steroids and proper monitoring of blood sugar levels in COVID-19 patients, before the outbreak of the third wave, as these causes were believed to have caused the spurt in mucormycosis cases during the second wave.
Rajsekhar Vedantam, Professor of Neurosurgery, CMC, Vellore, another distinguished speaker, gave a presentation on ‘Neurosurgical intervention in mucormycosis’. He said that the role of neurosurgeons in the ultimate outcome of mucormycosis patients was minimal like debridement of the infected brain tissue.
Earlier, in his opening remarks, Vinod Kumar V, Project Director, AP Health Systems Strengthening Project (APHSSP), spoke of his association with Andhra Medical College.
P.V. Sudhakar, Principal, AMC, who was the moderator for the CME, said that the webinars were started during the first wave of COVID-19. He said of the 186 mucormycosis patients treated at KGH, a majority had prior COVID-19 infection and only two patients had no COVID-19.
M.V. Vijaysekhar, neurosurgeon, AMC/KGH, said that nine patients were operated for intracranial extension of mucormycosis. Minimally invasive procedures were done in two cases.
