Table 3.
Clinical features of mucormycosis, treatment and outcome
| Patient number | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Follow-up days from COVID-19 discharge to mucormycosis symptoms | 4 | 10 | 7 | 7 | 10 | 14 | 7 | 8 | 7 | 7 | 5 |
| Classification of mucormycosis | |||||||||||
| ROCM without brain involved | – | – | – | Y | Y | Y | Y | Y | Y | Y | |
| ROCM with brain involved | Y | – | Y | – | – | – | – | Y | – | – | – |
| Pulmonary | – | Y | – | – | – | – | – | – | – | – | – |
| Signs and symptoms | |||||||||||
| Proptosis | Y | – | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Orbital cellulitis | Y | – | Y | Y | Y | Y | – | Y | Y | – | Y |
| Chemosis | Y | – | Y | – | Y | Y | – | Y | Y | – | – |
| Epistaxis | Y | – | Y | – | Y | – | – | – | – | – | – |
| Ophthalmoplegia | Y | – | Y | – | Y | Y | – | – | – | – | – |
| Vision loss | Y | – | Y | – | – | – | – | – | – | – | – |
| Blurred vision | – | – | – | Y | Y | Y | – | – | – | – | – |
| Facial swelling | Y | – | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Paresthesia | Y | – | Y | – | Y | Y | – | – | – | – | – |
| Foul smelling discharge | Y | – | Y | – | – | Y | – | – | – | – | – |
| Black discharge form nose/mouth | Y | Y | Y | – | – | – | – | – | – | – | – |
| Unremitting fever | – | Y | – | – | – | – | – | – | – | – | – |
| Unresolving pneumonia | – | Y | – | – | – | – | – | – | – | – | – |
| Tooth ache | Y | – | Y | – | – | – | – | Y | – | – | – |
| Pus discharge in oral cavity | – | – | Y | – | – | – | – | – | – | – | – |
| Nasal crusting visible | Y | – | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Palate crusting visible | Y | – | Y | – | – | – | – | – | – | – | – |
| Headache | Y | – | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Treatment | |||||||||||
| Cumulative median dose of liposomal amphotericin B (mg/kg) | 290 | 280 | 280 | 210 | 240 | 420 | 400 | 260 | 240 | 480 | 210 |
| Oral posaconazole | Y | – | – | – | – | Y | – | Y | Y | Y | – |
|
Duration of treatment (days) |
29 | 30 | 28 | 21 | 24 | 62 | 40 | 26 | 24 | 64 | 21 |
| FESS | Y | – | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Outcome | |||||||||||
| Baseline S. creatinine before COVID-19 (mg/dl) | 1.3 | 1.4 | 1.6 | 1.4 | 1.2 | 1.8 | 1.1 | 1 | 1.2 | 1.3 | 2.1 |
| Peak S. creatinine during COVID-19 (mg/dl) | 2 | 1.5 | 2.1 | 1.9 | 1.2 | 2.3 | 1 | 1.1 | 1.3 | 1.5 | 3.2 |
| AKI during COVID-19 | Y | Y | Y | Y | – | Y | – | – | – | – | Y |
| S. creatinine before mucormycosis (mg/dl) | 1.8 | 1.6 | 2.8 | 2.2 | 1.2 | 1.9 | 1.2 | 1.3 | 1.4 | 1.3 | 3.4 |
|
Peak S. creatinine during mucormycosis treatment (mg/dl) |
HD | HD | HD | 2.8 | 2.2 | 2.1 | 1.2 | 1.6 | 1.7 | 2.1 | 3.6 |
| AKI during treatment | Y | Y | Y | Y | Y | Y | N | Y | Y | Y | N |
| Creatinine at last follow-up (mg/dl) | HD | HD | HD | 1.5 | 1.3 | 2.1 | 1.1 | 1.2 | 1.4 | 1.3 | 2.6 |
| Graft recovery | N/A | N/A | N/A | C | C | P | C | C | C | C | P |
| Died | Y | Y | Y | – | – | – | – | – | – | – | – |
| Discharged | – | – | – | Y | Y | Y | Y | Y | Y | Y | Y |
FESS functional endoscopic sinus surgery; Case 2 was planned lung lobectomy, but died before surgery; Cases 6 and 10 are on 18th day and 17th day of amphotericin B and both are improving after FESS. Case number 1 underwent orbital exenteration; AKI acute kidney injury, Y yes, N no, HD hemodialysis, N/A not applicable, C complete (serum creatinine reached baseline at follow-up), P partial (serum creatinine declined but did not reach baseline levels)