Invasive fungal disease a symptom of COVID-19, say doctors

Doctors see a surge in patients with the infection; symptoms are reported a few weeks after a patient tests positive

Although the loss of smell and taste are among the most common symptoms of COVID-19, doctors are now seeing a number of patients coming in with an invasive fungal infection.

While doctors have been reporting a number of post-COVID manifestations in patients, ENT specialists are seeing a surge of COVID-19 patients — especially diabetic patients, the elderly and those with immuno-suppressed conditions — with an invasive fungal infection of the sinuses, which gradually enters the eyes and the brain.

“We are seeing an invasive fungal disease. Mucor is a very aggressive fungus. Patients with diabetes or immuno-compromised conditions are coming in with this complication. The fungus invades the sinuses and goes into the orbit and the brain. This could be lethal,” said Mohan Kameswaran, managing director of the Madras ENT Research Foundation.

The disease had been seen from March, but doctors were now treating patients with these symptoms at least five to six times more, he added. “The problem is that it spreads like wildfire to the skull base and then impacts the brain. This is seen not only in patients with uncontrolled diabetes, but also in patients with moderate and mild diabetes. In other cases, COVID-19 may have interfered with the immunity, or the ability to fight against lethal diseases,” Mr. Kameswaran said.

Venkatakarthikeyan C., consultant ENT head and neck, skull base surgery, Apollo Hospitals, said they had also treated such patients recently. “This is the worst category that we have seen among patients who test positive for COVID-19. They come in with complains of double vision, decreased vision, complete loss of vision, altered sensorium, facial swelling and palatal erosion. If a patient has facial swelling or symptoms that impact the eyes, it is important to consult an ENT doctor as soon as possible,” he said.

These symptoms usually present themselves a few weeks after a patient tests positive for COVID-19. He said a reason for this could be either due to diabetes or because the COVID-19 infection itself has altered a patient’s immunity, possibly due to a high dosage of steroids. Patients with other conditions, including renal failure or those undergoing chemotherapy, could also be affected.

Three-fold approach

The symptoms included a decrease or a blurring of the vision, the bleeding of the nose and a persistent nasal obstruction. “We take a three-fold approach to treat such patients. We try to reverse the immuno-compromised condition, including trying to control blood sugar levels in case of diabetes or stopping the intake of high-dose steroids. We need to reverse the immuno-compromised status, confirm if it is a fungal infection and then do an aggressive operation in which we debride as much unhealthy tissues as possible. Simultaneously, we start the patients on anti-fungal medications. The prognosis is good if a patient comes in as soon as the sinuses are involved,” he added.

Apart from this, patients with COVID-19 come in with minor symptoms, including a loss of smell and taste, and recover in a week to a month’s time, the doctors said.

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