Doctors say her untreated diabetes could have allowed mucormycosis to spread; say can’t always blame Coronavirus
Khatoon before and after mucormycosis
‘Mujhe ghar le chalo, bachon ke pass (take me home, I want to be with the kids),” said Mohsina Khatoon as she was being taken to Lucknow airport to board a flight for Mumbai on May 11. She raised hopes of everyone with signs of recovery from severe mucormycosis infection, only to suddenly sink and die a week later. The death of the 43-year-old belies the common belief that the fungus attacks those who have had a brush with Covid-19.
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Khatoon was diagnosed with ‘Intra Cerebral Extension of Mucormycosis with orbit maxilla and palat involvement’, requiring major surgery.
Her family says doctors in Lucknow were concerned about her post-operative care. They airlifted her to Mumbai.
At Sushrut Hospital, Chembur, a team of 12 surgeons began operating on Khatoon at 7 pm the same day and it went past midnight till 2 am. The mucar had penetrated deep into her skin, bone and blood vessels. Her right eye had to be removed and the right side of orbit maxilla and palat were separated. Her Covid-19 tests were negative.
Also Read: Black fungus found in brains of many patients in Indore hospital
Khatoon showed good response and her husband Mohammed Akaram, 46, and nephew Wasim Khan, 22, were amazed to see her taking a stroll inside the ward on the sixth day.
“She had lost her right eye and a part of the face, but we were pleased that she was alive. However, on May 18, her sugar level dropped to 49. Doctors found that she had developed a brain haemorrhage at a non-operated part of small brain area. She passed away the following day,” Wasim told mid-day.
No Covid-19 case in village
Wasim said Khatoon’s village has a population of 2,300 and they have no case of Covid-19 so far. The mother of four would help her husband in farming.
Khatoon got a mild fever on April 26 and vomited non-stop. Her sugar level shot up to 600 mg/dL. Doctors at Globe Medicare hospital in Lucknow brought her sugar levels to 200 and began treating her for mucormycosis. “They continued to treat my aunt until they advised to give up on her saying medicines were not able to stop the spread of the fungus,” said Wasim. Their relatives in Mumbai then contacted Dr Prashant Kewle at Sushrut Hospital.
“We had never heard of this fungal ailment. We should have got her to Mumbai earlier. The family and relatives, who financially supported her treatment, are in shock. We airlifted her body on May 19 and buried her at the village,” said Wasim.
Dr Shashank Joshi, consulting neurosurgeon who operated on Khatoon said, “The fungus involving the brain is a rare condition, which specifically affects diabetic and low immunity patients. Most of the time the medical line of treatment can take care of unless it causes a stroke. In that situation either through the nose or sometimes even the skull needs to be opened to get rid of the fungus.”
Dr Joshi said they have had many cases before Covid-19. “But now we are seeing more of these patients and they need surgical removal of the affected portion.”
The expert said the initial step involves the removal of damaged tissues since the fungus causes inflammation and obstructs blood flow to areas near facial bones, including sinuses and cheek. “So, there is no other way out but to remove the diseased part. This is lifesaving as antifungal medicines cannot reach the diseased tissue due to blockade of blood vessels.”
“Whenever brain is affected then neurosurgeon amongst the team is the key person to decide the extent of surgical excision,” added Dr Joshi.
Dr Kewle, HOD ENT Anterior Skull base surgeon, said, “We were hopeful that we would be able to save her and she had responded well to the initial surgery, wherein mucormycosis extensive debridement was done. The second part of surgery would have involved reconstruction of defect-free flap, but unfortunately, she developed a small haemorrhage in small brain, which was not affected by the mucormycosis and she breathed her last.” He said the hospital helped the family with concessions and fundraising.
Dr Kewle said, “Her untreated diabetes might be the core reason for her getting infected by mucormycosis.”
Dr Kewle said endoscopy can detect the fungal infection and early surgery can be beneficial. “If vision is lost, eyeball preservation is of no use and it may add to the further requirement of surgery and more antifungal injection. Optimal and radical surgery should be planned as per MRI findings. We need to conduct extensive research as the myth that mucormycosis only affects patients who have recovered the second wave of Covid-19 is debatable, especially after the Kahtoon incident.”
Attempts to contact Dr Deepak Aggarwal, Gastroenterologist, who runs Globe Medicare hospital Lucknow, did not yield any result.
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