We are aware about the various ill effects of COVID infection. The number of cases of Mucormycosis of Nose, Paranasal Sinuses, Orbit, Brain and lungs is on the rise. This is commonly seen in immune-compromised patients who are suffering from Diabetes, Chronic Renal Disease, Cancer, HIV, Immunosuppressive drugs/ disorders etc. In such cases, patients usually present late mostly with dry nose, proptosis and vision loss along with mild to moderate desaturation, though they are Covid RT-PCR negative.

These patients usually have history of early/ excessive use and/ or non-judicious use of steroids and poor hyperglycemic controls. Also the rise in IL-6 and ferritin levels can cause free iron release and becomes an important cause of mucormycosis in both diabetic and non-diabetic patients. Moreover increase use of oxygen and masks along with poor nasal, oral and ocular hygiene predispose to the growth of fungi.
 
Symptoms/ Signs:

1. Foul smelling nasal discharge, Halitosis
2. Oral mucosa/ Palatal discoloration, loosening of teeth
3. Crusting in nose, blood tinged discharge
   Facial paresthesia/ skin discoloration
4. Ptosis, Chemosis, Proptosis, Vision loss
   Headache, Neurological deficit, Intracranial extension
5. Vascular/ Cavernous Sinus Thrombosis
6. Persistent cough, Fever, Chest pain, Dyspnea, Hemoptysis
    
   Management includes early diagnosis, CT scan, MRI, Surgical debridement, Antifungals including Amphotericin B, Isavuconazole, Posaconazole and treatment of underlying immune-compromised conditions.

I sincerely request my colleagues to keep an eye on the nasal, ocular and facial hygiene during Covid patients’ management and timely referrals to ENT surgeons, Neurosurgeons and Ophthalmologists for immediate help to prevent and treat this deadly mucormycosis.