Mumbai: Covid-19, Mucormycosis and coronavirus again stumps health experts

Intertwinement of Covid19 and mucormycosis in some patients has stumped health experts These patients got Coronavirus first got discharged only to show signs of mucormycosis They again tested positive during treatment for the fungus Looking for clues HBT Medical College and Dr R N Cooper Hospital is studying 26 mucormycosis patients including a few from remote areas of Maharashtra who were admitted in May and June Of these five became Covid19 positive for the second timeCooper doctors said all five patients are stable now and one of them will be discharged by this weekend Representation picDr Shailesh Mohite dean of the medical college said ldquoThe five patients who were recently operated upon by our ENT team under Professor and Head of the Department Dr Ninad Gaikwad are doing well and they continue to be under the care and observation of our multidisciplinary team of experts One of them is likely to be discharged by this weekendrdquoNever seen beforeDr Vinod Gite Associate Professor Additional Department of ENT amp Head Neck surgery who operated on these patients said ldquoWe have not come across such cases before Patients who recovered from Covid19 and without any symptoms are developing a second active infection amidst battling mucormycosis In all the five patients we had to remove the eye in one case and in another case we could save the vision by timely arresting the fungal spread Two of the patients are though RTPCR positive they are asymptomaticrdquoDr Gite said one of the patients was 54yearold Rahul Jadhav named changed who was treated at the NESCO jumbo Covid19 centre for about 20 days till May 4 when discharged with RTPCR negative report But the same day Jadhav who lives within the limits of Kalyan Dombivli Municipal Corporation had slight swelling on his cheek and left eyeJadhav informed a relative who is the head matron at Cooper hospital forwarded a photograph of Jadhavrsquos face to Dr Gite ldquoI suspected something was wrong and advised the matron to get her relative Jadhav to Cooper immediately The patient arrived the next evening Various scans done at the hospital suspected mucormycosisrdquo said Dr GiteDoctors put Jadhav on lsquoAmphotericinbrsquo and sought opinions from other departments ldquoUnfortunately due to rapid spread of infection the patient had lost vision in one eye even after starting the antifungal treatment and the eye was removed post confirmation of biopsy which correlated our findings of mucormycosisrdquo Apart from the eye the patient needed removal of the complete left upper jaw cheekbones with teeth40 days under treatmentDr Gite said ldquoPostsurgery patients needed nonCovid19 ICU care with oxygen supplementation as his lung was affected due to his first Covid19 infection His condition deteriorated with all signs of repeat Covid infection with need for noninvasive ventilation He tested Covid19 positive again and was shifted to Covid19 ICU where intensivists started extensive treatment and the patient recovered Itrsquos almost 40 days under treatment with 2 Covid19 infections and 2 major surgeriesrdquoDr Gite appreciated the patientrsquos spirit ldquoI have never seen a patient with such willpower throughout his ups and downs he kept on assuring us that he would recover and requested us not to ever put him on ventilator support And he has fought Covid19 twice and this time even mucormycosis His vision in the other eye is stable and he can see and will need other cosmetic surgical intervention after two to three months of observation This patient will be discharged by this weekendrdquo said Dr GiteThe other such patients included a woman in her midthirties from Jalna and a male patient from Buldhana district Dr Gite added ldquoWe will be publishing their research on these five patients in coming months highlighting postoperative care and subsequent line of treatment and surgical interventions the patients underwent so that the same can be used as reference for futurerdquoFungal spread in scanDr Shradha Maheshwari Professor of Neurosurgery at Cooper hospital shed more light on these two cases ldquoThe ENT team got their MRICT scans as a routine practice preENT surgical intervention on both patients and their scans showed intracranial extension of the fungal spread and neurosurgical opinion was required to rule out if any neurosurgical intervention was needed Luckily the intracranial spread of fungus was not large and we decided to curtail the spread with medicinesrdquo she saidDr Maheshwari added ldquoThe two patients are gradually recovering and the latest scan report shows that medicines are working on them and the fungal spread is under controlrdquo2No of asymptomatic patients during second infection at Cooper