Palliative oral care for COVID-19 associated oral mucormycosis in diabetic patients : Journal of Family Medicine and Primary Care

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Letter to Editor

Palliative oral care for COVID-19 associated oral mucormycosis in diabetic patients

Rathee, Manu; Jain, Prachi; Alam, Maqbul

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Journal of Family Medicine and Primary Care: August 2022 - Volume 11 - Issue 8 - p 4867-4868
doi: 10.4103/jfmpc.jfmpc_1274_21
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Dear Sir,

This correspondence is regarding a spike observed in cases of mucormycosis as co-infection or as sequelae of COVID-19 infection. Mucormycosis is an invasive and potentially fatal fungal infection caused by the mold fungi especially evident in cases where the immune system is suppressed like diabetes, malignancy, patients on immunosuppressive drugs, or corticosteroid therapy.[1] Literature suggests that COVID-19 may be associated with immune dysregulation with decreased CD4+ and CD8+ lymphocytes. The cascade of events results in an increased risk of developing severe fungal infections.[123] Vulnerability is observed to be greater in patients requiring intensive care unit admission, mechanical ventilation, and in the nasogastric tube-fed patients. After surgical debridement of the dead tissues, the patients with maxillary osteomyelitis may face difficulties in deglutition, articulation impairment, and nasal regurgitation due to communication between the nasal and the oral cavity.

In view of the time-sensitive challenges presented by COVID-19, the patients with oro-nasal communication due to post-COVID-19 mucormycosis can be offered palliative treatment through a simple self-cure acrylic plate or an interim obturator [Figure 1].[4] The primary objective is the closure of the defect and re-establishment of oro-nasal integrity. A quick impression can be made with irreversible hydrocolloid impression material and to minimize the number of visits during this pandemic, a self-cure acrylic palatal plate can be fabricated and delivered on the same day.

Figure 1:
(a) Oro-nasal communication from surgical debridement of dead tissues in patient with mucormycosis post COVID-19. (b) Acrylic resin interim prosthesis in-situ

Potential benefits of this interim prosthesis include reduction in the pain and suffering of the patient achieving the oro-nasal partition resulting in the establishment of oral functions such as speech, swallowing, mastication, and improvement of psychological well-being, thereby permitting the avoidance of nasogastric tube and improving the quality of life.[4] It reduces the risk of oral infections and helps in maintaining the nutritional status of the patient. Also, this palliative care requires a single visit and utilizes materials that are routinely used, easily available, non-invasive, cost-effective, and easy to maintain. This treatment prosthesis can later be replaced by definitive prosthesis restoring functions and esthetics.

The awareness about the possibility, unique characteristics, and key distinguishing factors of mucormycosis as an opportunistic fatal fungal co-infection and regular monitoring for early signs and their detection in vulnerable patient’s essential to avoid delay in diagnosis, treatment, and/or referrals. Any negligence in maintaining oral hygiene makes the patient susceptible to fall prey to opportunistic infections. Hence, the patients must maintain oral hygiene and follow a proper nutritional regime along with glycemic control particularly those with uncontrolled diabetes for prevention of post-COVID-19 mucormycosis.

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1. Sargin F, Akbulut M, Karaduman S, Sungurtekin H Severe rhinocerebral mucormycosis case developed after COVID 19 J Bacteriol Parasitol 2021 12 386
2. Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG Mucor in a viral land: A tale of two pathogens Indian J Ophthalmol 2021 69 244 52
3. Song G, Liang G, Liu W Fungal co-infections associated with global COVID-19 pandemic: A clinical and diagnostic perspective from China Mycopathologia 2020 185 599 606
4. Brandão TB, Migliorati CA, Vechiato-Filho AJ, Silva WG, Ribeiro ACP, Parise-Junior O, et al. Strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic Support Care Cancer 2021 29 11 5
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