COVID-19 pneumonia and mucormycosis a new challenging duo- rhino-occulo-cerebral mucormycosis: a case report

The pandemic of corona virus disease 2019 (COVID-19) has posed challenge not only in management of the primary disease but the emerging complications associated with COVID-19 has further complicated the course of disease. The course of COVID-19 disease is associated with infectious and noninfectious complications former include secondary bacterial and fungal infection adding to mortality and morbidity. COVID-19 disease associated candidiasis and aspergillosis have been reported as super infections but with the steroid and supplemental oxygen as mainstay treatment modality mucormycosis is now complicating the course of disease and presently posing challenge in India with already overburdened health care service. Mucorales is a saphrophytic fungi causes rhinocerebral infection involving nasal passages, sinuses, oral cavity and brain. It is usually seen in immunocompromised host and in diabetics with poorly controlled blood sugar level. High degree of clinical suspicion is needed to suspect and diagnose mucormycosis. It is a fatal disease because of its angioinvasive pathogenesis and treatment is promptly initiated to salvage mortality and morbidity. Authors report a case of rhino-oculo-cerebral mucormycosis in a middle-aged diabetic patient with severe COVID-19 disease

Hospital Acquired Infections: Preventable Cause of Mortality in Spinal Cord Injury Patients

Background: There is an alarming rate of morbidity and mortality observed in the trauma victims who suffer spinal cord injuries (SCI). Such patients are admitted immediately and stay for longer periods of time and thus are at risk of acquiring nosocomial infections. Aims: The aim of this study is to analyze the primary cause of mortality in SCI patients. Design: Retrospective study. Materials and Methods: We conducted a retrospective 4 year analysis of the postmortem data of 341 patients who died after sustaining SCI at a tertiary care apex trauma center of India. Epidemiological data of patients including the type of trauma, duration of hospital stay, cause of death and microbiological data were recorded. Results: On autopsy, out of 341 patients, the main cause of death in the SCI patients was ascertained to be infection/septicemia in 180 (52.7%) patients, the rest 161 (47.2%) died due to severe primary injury. Respiratory tract infections (36.4%) were predominant followed by urinary tract infections (32.2%), blood stream infections (22.2%), wound infections (7.1%) and meningitis reported in only 5 (2.1%) cases. Acinetobacter sp (40%) was the predominant organism isolated, followed by Pseudomonas sp (16.3%), Klebsiella sp (15.1%), Candida sp (7.8%), Escherichia coli (6.9%), Staphylococcus aureus (6.9%), Proteus sp (3.3%), Enterobacter sp and Burkholderia sp (two cases each) and Stenotrophomonas sp (one case). A high level of multidrug resistance was observed. Conclusions: Hospital acquired infections (HAI) are leading cause of loss of young lives in trauma patients; hence efforts should be made to prevent HAIs