Dermatological manifestations of mucormycosis during COVID-19 : IDOJ

Uncontrolled diabetes mellitus (DM) and prolonged use of corticosteroids are the most common predisposing factors for mucormycosis. In 1/3rd of patients with CAM, COVID ‑19 was the only underlying disease though 78% of them received corticosteroids during the management of COVID‑19. In 20% of CAM cases, DM was detected for the first time during the COVID‑19 disease suggesting the role of SARS‑COV2 in causing diabetes mellitus.⁵ Rhino‑orbital mucormycosis is the commonest presentation followed by rhino-cerebral and pulmonary mucormycosis.⁵ Rhizopus arrhizus is the commonest species isolated from CAM cases followed by Rhizomucor pusillus. It was found that he mortality rate (at 6 weeks) in the CAM (38%) is lesser than the non‑CAM cases (45%).

Primary cutaneous mucormycosis- It has two distinct presentations-

Acute necrotizing type

It is commonly seen in immunosuppressed individuals and at the site of trauma. It presents as erythematous macules, pustules, infiltrative plaques and retiform lesions rapidly progressing to cutaneous ulcers and necrotic eschar with a jagged margin.

Chronic granulomatous type

It is most commonly reported from China and India. It is seen in immunocompetent individuals at site of trauma. It presents as gradually progressive cutaneous plaques with variable amount of ulceration and scarring.

Secondary cutaneous mucormycosis-

It is the most common type seen in hospital and emergency settings and affects terminally ill and severely immunocompromised patients. Clinical presentation is similar to acute necrotizing mucormycosis.

Contiguous Mucormycosis

It occurs due to contiguous spread from the underlying structures like rhino‑cerebral mucormycosis which presents with oral ulcers, mucosal eschars, periorbital edema, periorbital

cellulitis, ophthalmoplegia, loss of vision and neurological deficits.

The majority of cases of CAM reported have been of rhino‑orbito‑cerebral mucormycosis where nose/sinus involvement occurs early and eye and intracranial infection occur in the advanced disease.

Diagnosis and Treatment

Molecular diagnosis is not recommended as its sensitivity and specificity are low. For cutaneous and subcutaneous mucormycosis, clinical presentation with direct microscopic examination using potassium hydroxide mount with or without calcofluor stain or histopathological examination is preferred.

Surgical removal of all infected tissue is essential for the successful management of mucormycosis. Liposomal amphotericin is the recommended first line of therapy. Posaconazole and isavuconazole may be used as an alternative. In resource‑poor settings, amphotericin B deoxycholate can also be used as first‑line therapy.

Increasingly older population, extended survival of immunocompromised hosts, and indiscriminate use of antimicrobials has led to an upsurge of systemic fungal infections. On top of that CAM has added to the burden of fungal infections. Thus dermatologists should be well aware of clinical presentations and treatment aspects to be prepared to tackle increasing number of these cases.

Source-

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