COVID-19 CO-RADS 6, CT Severity 20/25 with ?Mucormycosis

Are we jumping the Gun in cases related to COVID and black fungus? PS: I don’t recall ever studying coloured fungus during MBBS🤔 History 67 years old female admitted 16 days back with all symptoms of Covid including Hypoxia,Fever,Diarrhoea,Myalgia. Patient treated with all supportive care along with recommended medications as per COVID protocols.Improved gradually till day before yesterday. Posting case for discussion regarding mucormycosis. Patient is a K/c/o Type 2 DM with uncontrolled sugars on Ayurvedic Medications,SHTN,CAD. Patient was also on steroids,Zinc as per protocol

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There predisposing factors 1 uncontrolled diabetic on ayurvedic treatment 2 shtn cad 3 pt is on steroids 4 zinc therapy Yes presenting eye congestion with blackening on medial canthus and nasal bridge and maxillary sinus all signs and symptoms are manifested by MUCORMYCOSIS Needs opthalmic examination Nasal endoscopy to see extent of infection Consider surgical intervention ie debridement at earliest before it becomes nasocerebral MUCORMYCOSIS Start inj amphotercinB liposomal 5mg per kg per day Continue first for 14days and review therapy as it may go up to 28days Monitor nephrotoxicity of amphotercinB as pt is diabetic Rest of supportive treatment

Thanx dr Rakesh Kayasth (pt)
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Mucormycosis with Rhino-Ocular involvement Urgent management is necessary Strict glycemic control Manage if DKA if so Extensive debridement of necrosed tissue Tab Posaconazole 100mg tds Inj Amphotericin B Lipid Complex 5mg/kg daily, 3-6 weeks OR Inj Lyposomal Amphotericin B 10mg/kg daily, 3-6 weeks See Sodium & Potassium level RFT If hypokalaemia treat with KCL Antibiotics only when suspect secondary infection Early care to be taken by ENT, Eye surgeon Resiratory support If steroids, then tapper the dose with minimum days of interval

Thank you doctor
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Patients diabetic.. Control blood sugar maintenance medication use.. Treatment covid 19 protocol.. For fungal mucromycosis it's is both eyes viral conjunctivitis and eyelid fungal infection... Moxifloxacin keto eye drops QD 5 hours 7 days.. Antinflammatory eyes drops QD 5 hours 7 days.. Lubricant eyes drops QD 5 hours 7 days.. Antihistamines ointment cream use.. Cold compress.. 3times days Clean eyes regularly saline water solutions water.. Black Google's need... Cover the eyes.. Tab salnac-Sp sos Tab antifungal use.. Treatment start under hospital covid 19 protocol..

Thank you doctor
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High mortality with this presentation... Whatsoever protocol may be followed, only short dose of moderate dosage of steroids should be tried as per guidelines.... In diabetic patients, more caution is required as we are witnessing the rise in mucormycosis in Covid patients who have diabetes... Notapering is required....kindly do not prolong the steroids for more than 5 days

Thank you doctor
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Supporting factors for Mucormycosis 1. Covid 2. Uncontrolled sugars 3. Pt on steroids 4. Intake humidified O2 5. Redness of bulbar conjunctiva Investigations needed to be done to conform it is a mucormycosis. A CT PNS and a Diagnostic Nasal endoscopy, ophthalmic examination to check ophthalmoplegia and vision, diplopia etc Treatment In case of strongly indicated start amphotericin B parallel with investigation. Once controlled surgical debridement.

Thank you doctor
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Supporting factors for Mucormycosis 1. Covid 2. Uncontrolled sugars 3. Pt on steroids 4. Intake humidified O2 5. Redness of bulbar conjunctiva Investigations needed to be done to conform it is a mucormycosis. A CT PNS and a Diagnostic Nasal endoscopy, ophthalmic examination to check ophthalmoplegia and vision, diplopia etc Treatment In case of strongly suspicion start amphotericin B parallel with investigation. Once conformed surgical debridement.

Thank you doctor
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
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Case of Post Covid mucormycosis uncontrolled Diabetes . Very serious case . We have to focus on some important points 1-Sugar control by insulin 2-Oxygen only medical oxygen 3-Secondaries infection by antibiotics 4-Antifungal medication 5-Dietary supplements 6-Blood thinner treatment 7-Electrolyte balance and management 8-Vitals parameters monitoring 9-Stop steroids if not required 10- Eye care and treatment 11- Personal hygiene and sanitation

Nicely explained
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Yes,it's Mucormycosis(black fungus) : Besides covid tt as per protocol & recent guidelines of ICMR consult Ophthalmologist & Neurosurgeon for their expert opinions .lt may damage vision if not treated well . Others as adviced by Dr.S.Agrawal.

Thank you doctor
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it's Covid 19 Black Fungus / Mucormycosis Inj. Start Liposomal Amphotericin B - 5 mg /kg /day For 15-28 days Covid has to manage as per protocol Strictly maintain diabetes with Insulin Vital Organ functional Test Rest treat symptomatically

Thank you doctor
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