Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes

Abstract

It has been nearly two years since the pandemic caused by the novel coronavirus disease (COVID-19) has affected the world. Several innovations and discoveries related to COVID-19 are surfacing every day and new problems associated with the COVID-19 virus are also coming to light. A similar situation is with the emergence of deep invasive fungal infections associated with severe acute respiratory syndrome 2 (SARS-CoV-2). Recent literature reported the cases of pulmonary and rhino-cerebral fungal infections appearing in patients previously infected by COVID-19. Histopathological analysis of these cases has shown that most of such infections are diagnosed as mucormycosis or aspergillosis. Rhino-orbital-cerebral mucormycosis usually affects the maxillary sinus with involvement of maxillary teeth, orbits, and ethmoidal sinuses. Diabetes mellitus is an independent risk factor for both COVID-19 as well as mucormycosis. At this point, there is scanty data on the subject and most of the published literature comprises of either case reports or case series with no long-term data available. The aim of this review paper is to present the characteristics of COVID-19 related mucormycosis and associated clinical features, outcome, diagnostic and management strategies. A prompt diagnosis and aggressive treatment planning can surely benefit these patients.

Fatal invasive gastric mucormycosis: Two case reports

“…Surgical debridement of necrotic tissues is often required for invasive mucormycosis. 1 , 18 In our first patient, liposomal form of amphotericin B was not available in our country; thus, we started treatment with conventional amphotericin B at low doses which was stopped at the 5th day because of worsening of renal dysfunction, and we opted for the surgical debridement. As for the second patient, he did not receive this treatment since he was in a septic shock.…”

Alternate Special Stains for the Detection of Mycotic Organisms in Oral Cyto-Smears—A Histomorphometric Study

“…While mucormycotic infections present with certain identifiable features, the presentation does not remain specific for the disease. Infection by fungi such as Aspergillus or Fusarium can present with identical clinical features, making the diagnosis puzzling [19,20]. The management protocol for other fungal infections cannot minimize or prevent the extensive tissue destruction that Mucormycosis brings, and hence the misdiagnosis of this infection can significantly increase the mortality and morbidity.…”

COVID-19 Associated Mucormycosis (CAM)

“…Similar findings were noted by Janjua et al . [ 13 ] There was also a significant correlation between oral manifestation and Type of Mucormycosis with a P value of 0.000 [ Table 3 ] suggesting the palate is an untimely involved structure in the oral cavity.…”