INFECTIUOS DISEASES(MUCORMYCOSIS)
QUESTION1: What is the evolution of the
symptomatology in this patient in terms of an event timeline and where is the
anatomical localization for the problem and what is the primary aetiology of
the patient's problem?
1.
3
years ago- diagnosed with hypertension
2.
21
days ago- received vaccination at local PHC which was followed by fever
associated with chills and rigors, high grade fever, no diurnal variation which
was relieved on medication
3.
18
days ago- complained of similar events and went to the the local hospital, it was
not subsided upon taking medication(antipyretics)
4.
11
days ago - c/o Generalized weakness and
facial puffiness and periorbital oedema. Patient was in a drowsy state
5.
4
days ago-
a.
patient
presented to casualty in altered state with facial puffiness and periorbital oedema
and weakness of right upper limb and lower limb
b.
towards
the evening patient periorbital oedema progressed
c.
serous
discharge from the left eye that was blood tinged
d.
was
diagnosed with diabetes mellitus
6.
patient
was referred to a government general hospital
7.
patient
died 2 days ago
patient was diagnosed with
diabetic ketoacidosis and was unaware that he was diabetic until then. This
resulted in poorly controlled blood sugar levels. The patient was diagnosed
with acute oro rhino orbital mucormycosis . rhino cerebral mucormycosis is the
most common form of this fungus that occurs in people with uncontrolled
diabetes ( https://www.cdc.gov/fungal/diseases/mucormycosis/definition.html ) the fungus enters the
sinuses from the environment and then the brain.
The patient was also
diagnosed with acute infarct in the left frontal and temporal lobe.
Mucormycosis is associated with the occurrence of CVA ( https://journal.chestnet.org/article/S0012-3692(19)33482-8/fulltext#:~:text=There%20are%20few%20incidences%20reported,to%20better%20morbidity%2Fmortality%20outcomes. )
QUESTION2:
What is
the efficacy of drugs used along with other non-pharmacological treatment
modalities and how would you approach this patient as a treating physician?
The proposed management of the patient was –
1.
inj.
Liposomal amphotericin B according to creatinine clearance
2.
200mg
Iitraconazole was given as it was the only available drug which was adjusted to
his creatinine clearance
3.
Deoxycholate
was the required drug which was unavailable
https://pubmed.ncbi.nlm.nih.gov/23729001/ this article talks about the
efficacy and toxicity of different formulations of amphotericin B
along with the above
mentioned treatment for the patient managing others symptoms is also done by-
I.
Management
of diabetic ketoacidosis –
(a) Fluid replacement- The fluids will replace those lost through excessive urination, as
well as help dilute the excess sugar in blood.
(b) Electrolyte replacement-The absence of insulin can lower the level of several electrolytes in
blood. Patient will receive electrolytes through a vein to help keep the heart,
muscles and nerve cells functioning normally.
(c)
Insulin
therapy- Insulin reverses the processes that cause
diabetic ketoacidosis. In addition to fluids and electrolytes, patient will
receive insulin therapy
QUESTION 3: What are the postulated reasons for a
sudden apparent rise in the incidence of mucormycosis in India at this point of
time?
Mucormycosis is may
be being triggered by the use of steroids, a life-saving treatment for severe
and critically ill Covid-19 patients. Steroids reduce inflammation in the lungs
for Covid-19 and appear to help stop some of the damage that can happen when
the body's immune system goes into overdrive to fight off coronavirus. But they
also reduce immunity and push up blood sugar levels in both diabetics and
non-diabetic Covid-19 patients.
With the COVID-19 cases rising in India the rate of
occurrence of mucormycosis in these patients is increasing
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