{"id":9342,"date":"2021-05-17T17:25:17","date_gmt":"2021-05-17T12:25:17","guid":{"rendered":"https:\/\/drmohans.com\/?p=9342"},"modified":"2024-11-26T10:52:55","modified_gmt":"2024-11-26T10:52:55","slug":"rhino-orbito-cerebral-mucormycosis-in-diabetes","status":"publish","type":"post","link":"https:\/\/drmohans.com\/backend\/rhino-orbito-cerebral-mucormycosis-in-diabetes\/","title":{"rendered":"Rhino-orbito-cerebral Mucormycosis in Diabetes"},"content":{"rendered":"<h3><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone wp-image-9359 size-full\" src=\"https:\/\/oldlive.drmohans.com\/wp-content\/uploads\/2021\/05\/Dr-V-Mohans.jpg\" alt=\"Dr V Mohans Blog\" width=\"592\" height=\"150\" \/><\/h3>\n<h3><strong>Mucormycosis in Diabetes<\/strong><\/h3>\n<p>Rhino-orbito-cerebral <a href=\"https:\/\/www.cdc.gov\/fungal\/diseases\/mucormycosis\/index.html#:~:text=Mucormycosis%20(previously%20called%20zygomycosis)%20is,to%20fight%20germs%20and%20sickness.\" target=\"_blank\" rel=\"noopener\">mucormycosis<\/a> is an uncommon but serious fungal infection with high morbidity and mortality, caused by the angiotropic fungus. Mucormycosis has suddenly become a household term, causing great fear and panic during this second wave of <a href=\"https:\/\/en.wikipedia.org\/wiki\/COVID-19_pandemic_in_India\" target=\"_blank\" rel=\"noopener\">COVID pandemic in India<\/a>.<\/p>\n<p>It usually occurs in immunocompromised individuals including people with uncontrolled diabetes, hematologic cancers, HIV\/ AIDS, those with solid organ transplants or stem cell transplants and those on immunosuppressants like steroids.<\/p>\n<p>The suspicion or diagnosis of rhino-orbital cerebral mucormycosis triggers a medical as well as surgical emergency with special stress on the need for interaction and coordination among the inter-professional team to improve treatment outcomes in this life-threatening disease.<\/p>\n<figure id=\"attachment_9344\" aria-describedby=\"caption-attachment-9344\" style=\"width: 598px\" class=\"wp-caption alignnone\"><img decoding=\"async\" class=\"size-full wp-image-9344\" src=\"https:\/\/oldlive.drmohans.com\/wp-content\/uploads\/2021\/05\/Mucormycosis-in-Diabetes.jpg\" alt=\"Mucormycosis in Diabetes\" width=\"598\" height=\"227\" \/><figcaption id=\"caption-attachment-9344\" class=\"wp-caption-text\">Rhino-orbito-cerebral Mucormycosis in Diabetes<\/figcaption><\/figure>\n<h3><strong>Who is predisposed\/ at risk? <\/strong><\/h3>\n<ol>\n<li><a href=\"https:\/\/oldlive.drmohans.com\/high-risk-complications-in-diabetes\/\">Uncontrolled diabetes<\/a><\/li>\n<li>Immuno-suppression with steroids<\/li>\n<li>Treated for Covid-19 with immunomodulators or steroids<\/li>\n<li>Other comorbidities like malignancy, post-transplant<\/li>\n<li>Prolonged stay in ICU<\/li>\n<li>On mechanical ventilation\/oxygen therapy for a long period<\/li>\n<li>HIV\/ AIDS<\/li>\n<\/ol>\n<h3><strong>Symptoms <\/strong><\/h3>\n<ul>\n<li>Facial pain\/ cheekbone pain\/ toothache<\/li>\n<li>Sinus headache<\/li>\n<li>Stuffy nose<\/li>\n<li>Blood discharge from nose<\/li>\n<li>Redness of the eyes<\/li>\n<li>Double vision\/ blurry vision\/ sudden loss of vision<\/li>\n<\/ul>\n<h3><strong>Signs <\/strong><\/h3>\n<ul>\n<li>Facial swelling\/ discoloration<\/li>\n<li>Palatal eschar\/ Nasal Eschar (blackish material)<\/li>\n<li>Ptosis (drooping of the eyelid)<\/li>\n<li>Proptosis (protrusion of eye)<\/li>\n<li>Ophthalmoplegia (paralysis of eye muscles) \/ Restricted extraocular movements<\/li>\n<li>Pan-ophthalmitis<\/li>\n<li>Central Retinal Artery Occlusion (CRAO) with a cherry-red spot at the macula<\/li>\n<\/ul>\n<h3><strong>Do\u2019s to preven<\/strong>t<\/h3>\n<ul>\n<li>Control blood sugar level<\/li>\n<li>Judicious use of steroids<\/li>\n<li>Monitoring of blood glucose post-Covid-19 in individuals with and without diabetes<\/li>\n<li>Use of sterile water for humidifiers \u2013while on oxygen therapy<\/li>\n<li>Watch for early warning symptoms\/ signs<\/li>\n<\/ul>\n<p>Wear a clean mask and maintain personal hygiene<\/p>\n<h3><strong>Dont&#8217;s<\/strong><\/h3>\n<ul>\n<li>Do not use any medications like steroids or antifungal agents without consulting a physician<\/li>\n<li>Don\u2019t waste crucial time. Consulting your diabetologist \/ ENT doctor or Eye doctor immediately is essential.<\/li>\n<\/ul>\n<h3><strong>Investigations<\/strong><\/h3>\n<ol>\n<li>Haemogram<\/li>\n<li>Fasting \/ post-prandial blood glucose levels, <a href=\"https:\/\/oldlive.drmohans.com\/control-diabetes-it-is-easy-through-hba1c-testing\/\">HbA1c<\/a><\/li>\n<li>Renal function tests<\/li>\n<li>CT scan of Paranasal sinuses<\/li>\n<li>MRI scan of Brain and orbit<\/li>\n<li>Deep nasal swab\/sputum examination<\/li>\n<li>Diagnostic nasal endoscopy\/ broncho-alveolar lavage<\/li>\n<\/ol>\n<h3><strong>Management<\/strong><\/h3>\n<ol>\n<li>Urgent medical and surgical management by a team approach involving the Diabetologist, ENT specialist, Ophthalmologist, Intensivist, Maxillo-facial surgeon, Microbiologist and Neurologist.<\/li>\n<li>Tight control of blood glucose levels and management of diabetic ketoacidosis (DKA). DKA if present, will mostly need insulin for control.<\/li>\n<li>Increase frequency of self-monitoring of blood glucose by glucometer. If possible, use continuous glucose monitoring by wearing a sensor.<\/li>\n<li>If a patient is still on steroids, reduce the dose and discontinue it as soon as possible.<\/li>\n<li>To discontinue the immunomodulatory drugs, if the patient is on any.<\/li>\n<li>Proper guidelines of anti-fungal therapy like Amphotericin B or others.<\/li>\n<li>Extensive surgical debridement when indicated.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Mucormycosis in Diabetes Rhino-orbito-cerebral mucormycosis is an uncommon but serious fungal infection with high morbidity and mortality, caused by the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":16543,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[350],"tags":[],"class_list":["post-9342","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blogs"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Rhino-orbito-cerebral Mucormycosis in Diabetes | Dr Mohan&#039;s<\/title>\n<meta name=\"description\" content=\"Rhino-orbito-cerebral Mucormycosis in Diabetes, Rhino-orbito-cerebral mucormycosis is an uncommon but serious fungal infection with high morbidity and mortality, caused by the angiotropic fungus\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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