8.INFECTIOUS DISEASE(Mucormycosis, Ophthalmology, Otorhinolaryngology, Neurology) M.SRI SAI PAVAN ROLL NO :79 8TH SEM

 

A) http://manikaraovinay.blogspot.com/2021/05/50male-came-in-altered-sensorium.html

1) QUESTION: What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary aetiology of the patient's problem?

1. 3 years ago diagnosed with hypertension

2. 21 days ago he  received vaccination at local PHC which was followed by fever associated with chills and rigors, high grade fever.

3. 18 days ago he complained of similar events and went to the the local hospital, it was not subsided upon taking medication.

4. 11 days ago  he complained of Generalized weakness and facial puffiness and periorbital oedema. Patient was in a drowsy state

5. 4 days ago-

a. patient presented to casualty in altered state with facial puffiness and periorbital oedema and weakness of right upper limb and lower limb

b. towards the evening patient periorbital oedema progressed

c. serous discharge from the left eye that was blood tinged

d. was diagnosed with diabetes mellitus

6. patient was referred to a government general hospital

7. patient died 2 days ago

Patient wasn't aware of his diabetic condition until then. He was also suffering from diabetic acidosis.This resulted in poorly controlled blood sugar levels. The patient was diagnosed with acute rhinocerebral mucormycosis. Rhino cerebral mucormycosis is the most common form of this fungal disease that occurs in people with uncontrolled diabetes.The fungus enters the sinuses from the environment and then the brain.

The patient was also diagnosed with acute infarct in the left frontal and temporal lobe. Mucormycosis is associated with the occurrence of CVA

2) QUESTION: What is the efficacy of drugs used along with other non-pharmacological treatment modalities and how would you approach this patient as a treating physician?

The proposed management of the patient was –

1. inj. Liposomal amphotericin B according to creatinine clearance

2. 200mg Iitraconazole was given as it was the only available drug which was adjusted to his creatinine clearance

Management of diabetic ketoacidosis –

a) Fluid replacement- The fluids will replace those lost through excessive urination, as well as help dilute the excess sugar in blood.

(b) Electrolyte replacement-The absence of insulin can lower the level of several electrolytes in blood. Patient will receive electrolytes through a vein to help keep the heart, muscles and nerve cells functioning normally.

(c) Insulin therapy- Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, patient will receive insulin therapy

Granulocyte stimulating factors may also be used in the treatment of mucormycosis.

Hyperbaric oxygen can also be used as an adjunctive therapy.

3) QUESTION: What are the postulated reasons for a sudden apparent rise in the incidence of mucormycosis in India at this point of time?

I think it is because of the use steroids in an uncontrolled manner.

COVID 19 is not the first disease where steroids are used as one of the main stay of treatment (in severe cases) but what has gone wrong in the recent time is even the lay man who got infected with Corona started using steroids right from the day 1 with no monitoring by a specialised physician.And they are not following any specific course of treatment.As many of them are also diabetic patients the are getting succumbed to mucormycosis.And it is not ending with mucormycosis but various other fungii are emerging to cause an epidemic.

And another reason for rise in mucormycosis cases may be the usage of tap water in oxygen concentrators.As most of the patients are being diagnosed of Covid in late stages in the second wave many of them Are requiring oxygen concentrators for supplemental oxygenation.And due to Lack of the people are using tap water instead of distilled water which serves as reservoir for the growth of mucormycosis.So this may be one of the reason for rise in mucormycosis cases.