Mumbai: Covid-19, Mucormycosis and coronavirus again stumps health experts

Cooper Hospital will publish the findings of its study in the coming days. Representation pic

Intertwinement of Covid-19 and mucormycosis in some patients has stumped health experts. These patients got Coronavirus first, got discharged only to show signs of mucormycosis. They again tested positive during treatment for the fungus. Looking for clues, HBT Medical College and Dr R N Cooper Hospital is studying 26 mucormycosis patients, including a few from remote areas of Maharashtra, who were admitted in May and June. Of these, five became Covid-19 positive for the second time.

Cooper doctors said all five patients are stable now and one of them will be discharged by this weekend. Representation pic

Dr Shailesh Mohite, dean of the medical college, said, "The five patients who were recently operated upon by our ENT team under Professor and Head of the Department Dr Ninad Gaikwad are doing well and they continue to be under the care and observation of our multidisciplinary team of experts. One of them is likely to be discharged by this weekend."

Never seen before

Dr Vinod Gite, Associate Professor (Additional), Department of ENT & Head Neck surgery, who operated on these patients, said, "We have not come across such cases before. Patients who recovered from Covid-19 and without any symptoms are developing a second active infection amidst battling mucormycosis. In all the five patients, we had to remove the eye in one case and in another case we could save the vision by timely arresting the fungal spread. Two of the patients are though RT-PCR positive, they are asymptomatic."

Dr Gite said one of the patients was 54-year-old Rahul Jadhav (named changed), who was treated at the NESCO jumbo Covid-19 centre for about 20 days till May 4, when discharged with RT-PCR negative report. But the same day, Jadhav, who lives within the limits of Kalyan Dombivli Municipal Corporation, had slight swelling on his cheek and left eye.

Jadhav informed a relative, who is the head matron at Cooper hospital forwarded a photograph of Jadhav's face to Dr Gite. "I suspected something was wrong, and advised the matron to get her relative [Jadhav] to Cooper immediately. The patient arrived the next evening. Various scans done at the hospital suspected mucormycosis," said Dr Gite.

Doctors put Jadhav on ‘Amphotericin-b' and sought opinions from other departments. "Unfortunately, due to rapid spread of infection, the patient had lost vision in one eye, even after starting the anti-fungal treatment, and the eye was removed, post confirmation of biopsy, which correlated our findings of mucormycosis." Apart from the eye, the patient needed removal of the complete left upper jaw, cheekbones with teeth.

40 days under treatment

Dr Gite said, "Post-surgery patients needed non-Covid-19 ICU care with oxygen supplementation, as his lung was affected due to his first Covid-19 infection. His condition deteriorated with all signs of repeat Covid infection with need for non-invasive ventilation. He tested Covid-19 positive again and was shifted to Covid-19 ICU, where intensivists started extensive treatment and the patient recovered... It's almost 40 days under treatment with 2 Covid-19 infections and 2 major surgeries."

Dr Gite appreciated the patient's spirit. "I have never seen a patient with such willpower, throughout his ups and downs, he kept on assuring us that he would recover and requested us not to ever put him on ventilator support. And he has fought Covid-19 twice and this time even mucormycosis. His vision in the other eye is stable and he can see and will need other cosmetic surgical intervention after two to three months of observation. This patient will be discharged by this weekend," said Dr Gite.

The other such patients included a woman in her mid-thirties from Jalna and a male patient from Buldhana district. Dr Gite added, "We will be publishing their research on these five patients in coming months, highlighting post-operative care and subsequent line of treatment and surgical interventions the patients underwent so that the same can be used as reference for future."

Fungal spread in scan

Dr Shradha Maheshwari, Professor of Neurosurgery at Cooper hospital, shed more light on these two cases. "The ENT team got their MRI/CT scans as a routine practice, pre-ENT surgical intervention on both patients and their scans showed intracranial extension of the fungal spread and neurosurgical opinion was required to rule out if any neurosurgical intervention was needed. Luckily, the intracranial spread of fungus was not large, and we decided to curtail the spread with medicines," she said.

Dr Maheshwari added, "The two patients are gradually recovering and the latest scan report shows that medicines are working on them and the fungal spread is under control."

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No. of asymptomatic patients during second infection at Cooper