AbstractAim’s & Objective
1.To study the imaging characteristic and clinico-pathological relationship of mucormycosis in post covid patients.
2.To study the relationship between development of mucormycosis in post covid patients who received various treatment therapies (Including use of Corticosteroids/ Oxygen supplementation / Ivermectin / Remdesivir).
3.To assess the sensitivity & specificity of the abbreviated MRI protocol used in this study in diagnosis of mucormycosis.
Materials and Methods: A total of 75 Post COVID patients with clinical suspicion of mucormycosis referred to Department of Radiodiagnosis for an MRI scan in a Tertiary care Government Medical college, Maharashtra, India between May 2021 to July 2021 were included in this study. A 3T GE machine was used in this study with abbreviated Protocol for imaging PNS with screening of Brain & orbits. Axial T2 Propeller, Cor T2 STIR 3 mm, 3D Axial T1 Bravo, Axial T1 Fat Sat Pre-Contrast, Axial T1 Fat Sat Post Contrast and 3D Sag T2 CUBE sequences were used in this study. Gadoterate meglumine (DOTAREM) was used as the intravenous contrast. Along with the imaging features, data of all the volunteers including their symptoms, day/week of presentation with symptoms (For mucormycosis), co-morbidities, blood reports and therapy (For COVID treatment including drugs & supplemental Oxygen) were also recorded. All the images were analysed by three Senior Radiologists and the data obtained was analysed using appropriate statistical tests.
Results: In this study, mucormycosis was seen most commonly in 48 to 59 years age group with no predilection for either of sex (Male to female ratio: 1.2:1). Most patients presented with symptoms of facial pain and swelling (50/75, 66.6%) followed by headache (45/75, 60%) in 3rd week post discharge (24/75, 32%). Patients with history of Diabetes Mellitus (P value-0.001286) and those who had high ferritin levels (P value-0.000096) during their treatment course had positive correlation in development of mucormycosis. Maxillary (61/75, 81%) and ethmoid sinuses (52/75, 69%) were the most common sinuses involved with presence of Black Turbinate sign having significant correlation with development of mucormycosis (P value-0.03). No significant correlation with Oxygen supplementation (P value-0.45), use of corticosteroids (P value-0/187), low leukocytes counts (P value-0.485), Chronic Kidney Disease (P value-0.1117), Hypertension (P value-0.6047), Ivermectin (P value-0.1695) and Remdesivir (P value-0.4838) were obtained in this study. The sensitivity & Specificity of the MRI with Abbreviated Protocol was 82% and 55% respectively, with 17.3% and 10.6% false positivity & negativity. KOH mount / Histopathology was used as the Gold standard.
Conclusions: The abbreviated MRI protocol has significantly higher sensitivity and specificity in diagnosis of mucormycosis with reduction in scan time an additional feature. Most patients presented in 3rd week of post discharge in this study, suggesting special care and MRI evaluation if clinically indicated. Further studies are advised in validation of our abbreviated protocol and further developing a protocol for screening of mucormycosis in post covid patients particularly with presence of Diabetes Mellitus and High ferritin levels during their treatment. No significant correlation between oxygen therapy, Corticosteroids /Ivermectin and Remdesivir therapy in development of mucormycosis.
