COVID-19 associated Mucormycosis (CAM)

Abstract

Mucormycosis once considered a rare disease with an incidence of 0.005 to 1.7 per million, has become one of the greatest menaces during the coronavirus disease (COVID-19) pandemic. India alone has contributed to nearly 70% of the global caseload of COVID-associated mucormycosis (CAM) and it had even been declared as a notifiable disease. Second wave of COVID-19 pandemic saw a steep rise in the incidence of mucormycosis and these patients have been presenting to anesthesiologists for various surgical procedures due to its primary or secondary sequelae. Rhino-orbito-cerebral mucormycosis (ROCM) is the commonest manifestation and is caused by Rhizopus arrhizus. Injudicious use of corticosteroids in vulnerable patients could have been a major contributing factor to the sudden rise in ROCM during the pandemic. Concerns related to anesthetic management include COVID-19 infection and post COVID sequalae, common presence of uncontrolled diabetes mellitus, possibility of difficult mask-ventilation and/or intubation, various drug therapy-associated adverse effects, and interaction of these drugs with anesthetic agents. Thorough preoperative optimization, multidisciplinary involvement, perioperative care, and vigilance go a long way in improving overall outcomes in these patients.

Anesthetic Management of Mucormycosis Cases Requiring Surgical Debridement

“…Eye pain (60%) and eye swelling (48%) were the most prevalent symptoms. used with caution (5). The most commonly used antifungal treatment in our study was amphotericin-B.…”

“…The management of this condition typically involves a combination of surgical debridement of necrotic tissues along with long-term antifungal therapy. A key aspect of preventing further progression of the disease is to manage underlying predisposing factors such as diabetes, ketoacidosis, and the use of corticosteroids and immunosuppressants (5).…”

“…Postoperative ICU management is crucial due to the presence of coexisting conditions and rapid infection progression (14). One review reported that 28% of patients required postoperative mechanical ventilation due to extensive surgery (5).…”

“…During the pandemic, there has been an increase in cases associated with COVID-19 infection. The frequent use of corticosteroids in these patients may have contributed to COVID-associated mucormycosis (5).…”