Clinical characteristics of 62 cases of post covid-19 mucormycosis: Experience with MJPJAY from tertiary care center in North Maharashtra

Abstract

Introduction: Covid-19 pandemic, the dark chapter in human history started in Wuhan, Hubei Province, China on 31st of December 2019 when the 2019-nCoV associated pneumonia cases were reported to the World Health Organization (WHO) by the Chinese government. Very soon its black shadow covered almost every land of the globe.This black shadow of covid-19 uncertainty further darkened with the rise of black fungus, mucormycosis. Over 45,000 Cases Of Black Fungus Reported In India till 15 july2021as Parliament informed by a report from press trust of India. Aims and objectives: To study the clinical characteristics of post covid-19 mucormycosis cases and financial support management by Mahatma Jyotiba Phule Jan Arogya Yojana at our Government medical college Dhule in times of ongoing covid-19 pandemic. Material and Methods : This is a prospective observational study from 1st April 2021 to 15 July 2021. All patients having mucormycosis of the paranasal sinuses with or without having a history of coronavirus disease infection were included in the study. Detailed history and Clinical characteristics were recorded. Management included multidisciplinary approach. All clinical departments shared clinical management along with imaging and laboratory investigations. Intravenous liposomal amphotericin B and appropriate surgical procedures were the main stay of management. Results : All the patients were symptomatic with mucormycosis (n=62) and had recovered from covid-19 recently (n=61). Total 62 patients studied including 42 males (67.74%) and 20 females (32.25%). Mean age was 50.58 years. 61 patients (98.38%) had history of covid-19 infection confirmed by RTPCR test. Diabetes mellitus was present in 54 patients. Mean diabetes duration was 4.6 years and it was was not controlled in 28 cases.Covid-19 positivity (98.38%), Diabetes mellitus (87.09%) and steroid use (75.80% ) were prime risk factors noted. Hypertension (25.80%) and ischemic heart disease (06.54%) were next common comorbidities.The ethmoids (77.41%) were the most common sinuses affected followed by maxillary (58.06%).Majority of patients (67.74 %) had multiple sinuses involvement. The combination of ethmoid, maxillary and sphenoid sinuses involvement was most frequent. Intra-orbital extension was seen in 41.93% of cases, while intracranial extension was only seen in 17.74 %. The most common presentation was local pain, headache and swelling of face followed by nasal obstruction, nasal discharge and eyelid swelling.Serious eye signs were ptosis (19.35%), chemosis (17.74%) and impaired vision (17.74%).Intravenous liposomal amphotericin B was given to all patients for an averag 17 days. Exenteration was required in 10 patients(16.12%).No mortality noted. Under MJPJAY scheme enrollment of 53 (85.48%) cases were succeeded. Procedure packages for rhinocerebral mucormycosis (n=53), Endoscopic sinus surgery(n=17), orbital exenteration(n=10) were obtained. Till 1st august 2021, claim approved were 20, claims submitted or in process were 30 and claims pending were 3. From the approved 20 claims revenue generated costs Rs 8,00,000. Total expected revenue generation is Rs 26,25,000. Economically exhausted 53 families got financial support under MJPJAY. Conclusion: Post covid-19 immuno-compromised host in combination of uncontrolled diabetes is an ideal destination for mucorals to invade. Covid-19 and mucormycosis of the paranasal sinuses is a deadly combination. Already stretched families during coronavirus infection now got totally exhausted by this sudden financial crash. MJPJAY is a ray of light in the life of these exhausted families!