Mucormycosis Following Tooth Extraction in a Diabetic Patient: A Case Report

Maxillary Mucormycotic Osteonecrosis as a Manifestation of Post-COVID-19 Infection in Non-diabetic Patients: Report of Two Cases

Mucormycosis is a rare, opportunistic fungal infection prevalent in the elderly, especially in patients with uncontrolled diabetes or a compromised immune system. However, the outbreak of the pandemic declared by the World Health Organization in late 2019 increased the incidence of mucormycosis cases in COVID-19 patients due to increased steroid usage that resulted in an immunocompromised state. The current report presents two cases of oral mucormycotic osteomyelitis in patients who developed diabetes post-COVID infection, along with a review and relevant literature.

Exploring the Knowledge Regarding Mucormycosis and Its Management Among a Cohort of Dental Undergraduates in India: A Cross-Sectional Survey

INTRODUCTION

 Mucormycosis is an angioinvasive fungal infection associated with a high mortality rate in both low- and middle-income countries. A dentist plays a crucial role and first line in the diagnosis and treatment of mucormycosis since the majority of the site of infection is the rhino cerebral or rhino maxillary area. The present study was designed to ascertain knowledge about mucormycosis and its management among a sample of dental undergraduates in India.

MATERIALS AND METHODS

 A self-administered questionnaire covering demographic details, knowledge relating to underlying disease and risk factors (10 items), clinical features and diagnosis (8 items), and management of mucormycosis (six items) was employed. Responses were recorded on a dichotomous scale. Data analysis was done using SPSS 20 (SPSS Inc., Chicago, IL, USA). The mean and standard deviation for correct answers and knowledge levels were determined.

RESULTS

 A total of 437 respondents were included. Classification of participants based on the level of correct knowledge demonstrated that the majority of students had good knowledge (232, 53.1%). Comparison of the same based on the college type showed significant differences for only clinical features, diagnosis (p=0.002), and management (p=0.035) whereas no significance was seen for gender. Correlation by Karl's Pearson correlation coefficient revealed a significant positive correlation between the entire knowledge scores.

CONCLUSION

 The study portrays adequate knowledge among dental interns that can be used to modify preventive care measures to lessen the public health emergency. Stakeholders can take the necessary action to spread knowledge about mucormycosis through training workshops and continuing dental education programs to combat the health crisis.

Diagnosis and management of mucormycosis in the dental clinic: A guide for oral health professionals in India

With the current pandemic raging over the world, science and medicine is faced with hereto with unfought enemies or less fought opponent in the form of viruses and consequently, other biotic entities. While researchers are striving to identify and conquer the variants of COVID-19, other innocuous organisms are raising their ugly heads in the form of opportunistic fungal infections. Mucormycosis/Black Fungus is an invasive opportunistic fungal infection caused by mucorale species. It spreads through blood vessels causing thrombosis, ischemia, and necrosis. Population with pre-existing immunocompromised conditions such as Diabetes Mellitus, Malignancy, Long-term immunosuppressant therapy are more susceptible. Mucormycosis associated with Corona Virus Disease-2019 (COVID-19) proved to be catastrophic due to its high mortality rates. Rhino orbital Mucormycosis is the most common form. The primary care physician, being the first and often, (more so in developing countries) and being the only point of contact with a healthcare professional, plays a pivotal role in the diagnosis and management of this condition. The keystone to decreasing mortality is early detection and diagnosis followed by preventive measures to control progression to the brain. A multidisciplinary approach by various specialties is a prerequisite for effective diagnosis and management. Antifungal therapy, surgical debridement, and resection of the affected areas are protocols to be followed. Post-operative defects cause impairment of function, phonetics, and esthetics. Prosthetic rehabilitation of these defects has shown favorable results, especially in the aged and immunocompromised individuals.

Mucormycosis: An opportunistic pathogen during COVID-19

The pandemic of coronavirus disease 2019 (COVID-19) still remains on an upsurge trend. The second wave of this disease has led to panic in many countries, including India and some parts of the world suffering from the third wave. As there are no proper treatment options or remedies available for this deadly infection, supportive care equipment's such as oxygen cylinders, ventilators and heavy use of steroids play a vital role in the management of COVID-19. In the midst of this pandemic, the COVID-19 patients are acquiring secondary infections such as mucormycosis also known as black fungus disease. Mucormycosis is a serious, but rare opportunistic fungal infection that spreads rapidly, and hence prompt diagnosis and treatment are necessary to avoid high rate of mortality and morbidity rates. Mucormycosis is caused by the inhalation of its filamentous (hyphal form) fungi especially in the patients who are immunosuppressed. Recent studies have documented alarming number of COVID-19 patients with mucormycosis infection. Most of these patients had diabetes and were administered steroids for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and were consequently more prone to mucormycosis. Hence, the present review emphasizes mucormycosis and its related conditions, its mechanism in normal and COVID-19 affected individuals, influencing factors and challenges to overcome this black mold infection. Early identification and further investigation of this fungus will significantly reduce the severity of the disease and mortality rate in COVID-19 affected patients.