Mumbai: Rising mucormycosis cases in children worry medicos

Janaki Nandan is the youngest to have been diagnosed with mucormycosis at an AP hospital

Mumbai pediatricians, ophthalmologists and ENT surgeons are getting increasingly concerned about the rapid rise in mucormycosis cases among children. A four-year-old cancer survivor from Chhattisgarh, and a six-year-old from Mumbra - have survived the infection, thanks to timely treatment.

There is also a 17-month-old child from Andhra Pradesh. Speaking to mid-day, Dr Mahalakshmi Ravula, medical superintendent at Government General Hospital, Kakinada, Andhra Pradesh, confirmed the admission of 17-month-old Janaki Nandan at their Pediatric Intensive Care Unit (PICU) on May 28, and that MRI and microbiology tests have confirmed it to be mucormycosis.

Dr Mahalakshmi said, "We have around 60 adult patients who have recovered from Covid-19 and 10 Covid-19 positive adults suffering from mucormycosis. Nandan is the youngest to have been diagnosed with mucormycosis. Our team will be operating on him on Thursday."

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Dr Venkateshwara Machavaram, associate professor (ophthalmology) attached to the hospital, said, "The child has been given anti-fungal medicines and some improvement has been seen. He had nasal discharge and an eye and a side of the face was swollen and reddish. He had fever for a day after which he developed mucormycosis, but his RT-PCR test and Covid-19 reports were negative. The latest MRI report shows that oedema is present in his sinus and intra-orbital area, though vision in both eyes is fine. After surgery, the affected portions will be sent for histopathology analysis and culture, which will help us understand the underlying problem and treat accordingly."

Rise in pandemic

Dr Prithesh Shetty, consultant, Oculoplasty Ocular Oncology and Ocular Prosthesis at Khan Bahadur Haji Bachooali Ophthalmic hospital in Parel, said, "It is a known fact that mucormycosis has been infecting people before, but amidst the pandemic, we are witnessing a rampant increase in cases. Recently, I operated on a four-year-old cancer survivor and a six-year-old with no Covid-19 history (see box)."

"Parents of kids who are taking a immune suppressant or undergoing chemotherapy and steroid treatment, should be alert and look for early signs of the infection. Wearing a mask is a must, as the fungus is present in the atmosphere and can be inhaled," explained Dr Shetty.

Dr Shetty recalled the four-year-old cancer survivor from Chhattisgarh stating, "By the time the child came to us the vision in the left eye was lost. Once it reaches the eye next the disease spreads to the brain. So we had to act fast. Also we had to take special precautions as the kid was also on chemotherapy. We did enucleation on December 28, 2020. Fortunately, we removed the whole lesion and did a cosmetic correction. The kid was never Covid-19 positive. He was on steroids for long for chemotherapy."

Dr Prashant Kewle, HOD ENT Anterior Skull base surgeon at Sushrut Hospital, Chembur, said, "I have been, on an average since last month, conducting two surgeries a day for removal of mucormycosis, in patients between 20 years -70 years, with Covid-19. We must understand that mucormycosis was always tackled with medicine, but recent cases have shown rampant spread of necrosis, and until the tissues that are affected are not surgically removed, chances of the fungal spread are always high, with risk of repetitive infection."

"As compared to middle aged or elderly citizens, any surgical intervention in pediatrics, will always have scope for faster recovery. However, children who are on immune suppressants and fighting high-risk ailments, need to take extra precaution and their parents should ensure their immunity is not compromised," said Dr Kewle.

‘Adults more affected'

"Mucormycosis affects adults frequently than children. As the fungus affects blood vessels causing necrosis of tissues, controlling it only with medication is difficult. So, surgeries are carried out. Also, detecting mucormycosis may be challenging as kids may not complain early as adults can. It is important to counsel parents where a vision issue can warrant surgical removal of the affected eyeball. As Covid-19 has shown a sharp rise in the second wave, mucormycosis cases have also shown a drastic increase and have required surgical excision to control damage. This is partly a complication of Covid-19 causing low immunity, or side effects of medications, or worsening of diabetes, nobody is sure about it. With the decline of the second wave, we hope for reduction of mucormycosis as well," explained Dr Shashank Joshi, neuro surgeon.

Case studies

Patient 1

According to Dr Shetty, the 6-year-old from Mumbra was complaining of redness, pain and watering in the right eye for 10 days before being operated upon last month. An ultrasound of the right eye was suggestive of pan ophthalmitis (inflammation and infection of the whole eye). Doctors did an extended enucleation along with systemic antifungals.

Patient 2

A four-year-old kid, with leukaemia at Tata hospital, was presented to the Bachoo Ali hospital, Parel in December 2020 with a growth in the left eye ball. A biopsy was suggestive of mucormycosis plus aspergillosis. Dr Shetty said doctors had to do an extended enucleation plus wash with an antifungal injection into the eye.