Compromised immunity behind mucormycosis cases: Punjab-based study

CHANDIGARH: A sudden surge in the cases of mucormycosis during the second wave of the Covid-19 pandemic was probably due to a compromise in immunity, along with thrombotic microangiopathy among the infected patients, according to a latest Punjab-based study published in European Archives of Oto-Rhino-Laryngology.

Thrombotic microangiopathies refer to the destruction of red blood cells, low platelets and organ damage due to the formation of blood clots arteries.

With an aim to evaluate the disease presentation, patterns of spread, and its association with the Covid-19 virus, the study was conducted on patients undergoing surgery for invasive fungal at a tertiary care centre in Punjab, between March and July this year. Out of 34 patients, who underwent surgery for invasive fungal sinusitis, an inflammation of the sinuses, 31 — 21 men and 10 women — were diagnosed with mucormycosis. All the patients were either tested positive for Covid on presentation or had contracted the infection in the prior months. Some of them had radiological evidence of past infection with the virus.

Of the 31 cases operated, eight died. The cause of death was extensive intracranial extension, sepsis, cardiac arrest, and post-Covid complication in two patients each. Cheek numbness was the most common symptom reported in 87.1% of participants, headache in 83.9%, visual disturbances in 77.4% and palate involvement in 58.1% of patients. Blackening of turbinates — small structures inside the nose that cleanse and humidify air — was reported in 22.6% of the patients.

Diabetics with poor glycaemic control was common in all the patients. Besides severely compromising the immunity of the participants, the use of steroids in the treatment of Covid infection could have led to impaired macrophage function — detection and destruction of bacteria and other harmful organisms —and poor glycaemic control, providing an opportunity to infections such as mucormycosis.

The study, by Dr Pooja Pal and Dr Sumant Singla of Sri Guru Ram Das Institute of Health Sciences and Research, Vallah in Amritsar, and Dr Bikramjit Singh and Dr Rupinder Kaur of Government Medical College, Amritsar, observed that infection spread to soft tissues of the infratemporal fossa which is located at the base of the skull through neurovascular structures rather than by bone erosion.

Due to vague initial symptoms and ignorance pertaining to symptoms of the disease, patients often seek treatment at advanced stages. As mucormycosis is a rapidly progressive fungal infection with high morbidity, the researchers have recommended high level of suspicion while dealing with those with uncontrolled diabetes, especially with history of Covid-19 infection.