Diagnosis of rhinocerebral mucormycosis as complication of COVID-19, features of patient’s treatment

Abstract

Mucormycosis in patients after coronavirus pneumonia has become increasingly common. It is known that this disease has predominantly rhinocerebral form, is characterized by aggressiveness, rapid spread of the process to the brain tissue, and high mortality rate. Nevertheless, this pathology is insufficiently studied and described in the current scientific literature. Diagnosis of rhinocerebral mucormycosis is made at late stages, and serious complications cannot be avoided, and sometimes even save the patient. The aim was to study the possibilities of early diagnosis and prevention of rhinocerebral mucormycosis as a complication of COVID-19 and to consider the peculiarities of treatment of patients.
Materials and methods.
The article presents the examination and treatment data of 7 patients with rhinocerebral mucormycosis after coronavirus pneumonia. Radiation methods included orthopantomography, multispiral computed tomography (MSCT), magnetic resonance imaging. The diagnosis of mucormycosis was confirmed by pathohistological examination. The treatment of the patients was complex. Surgical methods included removal of foci of soft and bone tissue lesions. In the postoperative period we performed dynamic observation, daily dressings. As conservative treatment systemic antifungal therapy (amphotericin B and posaconazole), symptomatic treatment were used.
Results.
As a result of clinical, radiological, histological, laboratory investigation the picture of rhinocerebral mucormycosis after coronavirus pneumonia at different stages of the disease was described in detail and the results of treatment were estimated.
Conclusion.
Early diagnosis of rhinocerebral mucormycosis is based on the detection of symptoms of maxillary sinusitis developed after coronavirus pneumonia. Risk factors may include type 2 diabetes mellitus, cardiovascular pathology, and prior long-term therapy with high-dose glucocorticosteroids. MSCT should be considered as a method of choice for early diagnosis of the disease, to determine the extent of the process. Histological examination of biopsy and surgical material can be used for diagnosis. Treatment of patients should be comprehensive and include early radical surgical removal of the affected tissues against the background of systemic antimycotic therapy. Timely diagnosis of the disease and comprehensive treatment can reduce mortality and increase the life expectancy of patients.