Mucormycosis And Invasive Fungal Infections Treatment Clinic in Dombivli

FIRST TIME IN THANE DISTRICT

MUCORMYCOSIS CLINIC

Highlights

MULTIDISCIPLINARY TEAM APPROACH

  • MAXILLOFACIAL SURGERY
  • OPTHALMIC SURGEON
  • ENT SURGEON
  • MAXILLOFACIAL PROSTHODONTICS FOR POST SURGERY REHABILITATION
  • MD PHYSICIAN

WHO SHOULD VISIT FOR MUCORMYCOSIS

  • HISTORY OF COVID
  • NASAL DISCHARGE
  • FACIAL SWELLING
  • PAIN AROUND EYES
  • PALATAL DISCHARGE
  • NUMBNEES ON FACE
  • MOBILITY IN TOOTH
  • FACIAL PAIN

EARLY AND PROMPT DIAGNOSIS AND TREATEMENT

  • BIOPSY
  • CHECK SCOPY
  • FESS (FUNCTIONAL ENDPSCOPIC SINUS SURGERY)

ADMISSION FACILITY IN NETWORK HOSPITAL

Vishnu Nagar

101, 1st Floor, Siddhivinayak Arcade, Phule Road, Vishnu Nagar, Above Syndicate Bank, Dombivli West.

+91 9930338312   drghaisasdentalclinic@gmail.com

What is Mucormycosis?

As the covid pandemic is making all of us struggle in different ways, I would like to put some light on recent blast in cases of post covid mucormycosis. Mucormycosis is a type fungal infection caused by the fungi in the order Mucorales. Air borne spores land on nasal/oral mucosa if immunologically incompetent spores are not contained by phagocytic response and gemination ensues.

Exact cause of post covid mucor mycosis is unknown but may be because of Immunosuppression caused by –

  • Covid
  • Underlying systemic disease s/a DM
  • High dose Steriods
  • Drug induced – Remdesivir, Toclizumab
  • Or because of increase in serum iron load seen because of inflammation due to cytokine storm in covid cases.

Mostly affects maxilla and paranasal sinuses but some mandibular cases are also being reported.

Signs and symptoms-

  • Mobility in teeth with or without periodontal/gingival abscess
  • Nasal discharge
  • Perforation in palatal mucosa
  • Low grade fever
  • OpG may be completely normal
  • Palatal or nasal mucosa necrosis or black eschar
  • Sinusitis
  • Headache

Mucormycosis spread is rapid and can affect maxillary alveolus , maxillary sinus ,orbit and eventually intracranial involvement can take place As it spreads upwards it can cause chemosis, proptosis ,blindess, cavernous sinus thrombosis , cerebral ischemia, infarction and death.

As tooth acehes or extraction can be associated with onset of symptoms dentist should be extremely vigilant in diagnosing such cases. Thus history undertaking and prompt consultation plays a vital role in early diagnosis.

  • Best diagnosed by KOH staining
  • Fungal culture and biopsy
  • Fungal culture and biopsy/

CT scan/MRI

Management involves a mutimodal approach..mucor is not a diesase which just affects soft tissues ..I also affect hard tissues, many times only FESS is inadequate leading to relapse later … bony involvement is not seen in CT in intial stages .. CT scan will show bone related change only after 30 % decalcification leading to insufficient debridement ..

Main principle in management is to debride till vascular bed is created which will induce angiogenesis ..

Blood Investigations : CBC , PT, INR , RFT, LFT, BSL, ESR , CD4 ,CD8, HHH

Surgical Part :

  • Surgical debridement of the affected area
  • Debridement of maxillary sinus
  • Endoscopic debridement of Ethmoid , Sphenoid sinus
  • Hemi / Total maxillectomy
  • Orbital Excentration if orbit is involved

Medical Management

Early Administration of antifungal agent
Amphotericin B with strict monitoring of serum creatinine and urea as it highly nephrotoxic.
Newer agents s/a liposomal or liyophillised amphotericinB preferred as it less nephrotoxic

Dosage – upto 5 mg / kg of body weight
Dose adjustments in view of raised creatinin are needed.

Mucormycosis is deadly and has mortality upto 50%
With out surgery the mortality is 100%

Mucormycosis is deadly and has mortality upto 50% With out surgery the mortality is 100%. Surgery also leads to facial deformity and subsequent rehabilitation procedures are needed. It will affect patients financially and emotionally to great extent. Many maxillofacial surgeons and other doctors through out India are seeing rise in mucormycosis cases. So early diagnosis play a vital role.

Also all post covid patients should get a regular dental check up done and should be asked to wear clean masks and main oral hygiene by brushing thrice daily and using mouth wash at regular basis.

Dr Amol Ghaisas
MDS Oral and maxillofacial surgeon
Fellowship in Head and Neck oncosurgery
Contact No – 9833997421