Mumbai: Rising mucormycosis cases in children worry medicos

Mumbai pediatricians ophthalmologists and ENT surgeons are getting increasingly concerned about the rapid rise in mucormycosis cases among children A fouryearold cancer survivor from Chhattisgarh and a sixyearold from Mumbra have survived the infection thanks to timely treatmentThere is also a 17monthold child from Andhra Pradesh Speaking to midday Dr Mahalakshmi Ravula medical superintendent at Government General Hospital Kakinada Andhra Pradesh confirmed the admission of 17monthold Janaki Nandan at their Pediatric Intensive Care Unit PICU on May 28 and that MRI and microbiology tests have confirmed it to be mucormycosisDr Mahalakshmi said ldquoWe have around 60 adult patients who have recovered from Covid19 and 10 Covid19 positive adults suffering from mucormycosis Nandan is the youngest to have been diagnosed with mucormycosis Our team will be operating on him on ThursdayrdquoAlso Read Mumbai Covid19 negative woman dies of black fungus despite right surgeryDr Venkateshwara Machavaram associate professor ophthalmology attached to the hospital said ldquoThe child has been given antifungal 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 RTPCR test and Covid19 reports were negative The latest MRI report shows that oedema is present in his sinus and intraorbital 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 accordinglyRise in pandemicDr Prithesh Shetty consultant Oculoplasty Ocular Oncology and Ocular Prosthesis at Khan Bahadur Haji Bachooali Ophthalmic hospital in Parel said ldquoIt 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 fouryearold cancer survivor and a sixyearold with no Covid19 history see boxrdquoldquoParents 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 inhaledrdquo explained Dr ShettyDr Shetty recalled the fouryearold cancer survivor from Chhattisgarh stating ldquoBy 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 Covid19 positive He was on steroids for long for chemotherapyrdquoDr Prashant Kewle HOD ENT Anterior Skull base surgeon at Sushrut Hospital Chembur said ldquoI 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 Covid19 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 infectionrdquoldquoAs 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 highrisk ailments need to take extra precaution and their parents should ensure their immunity is not compromisedrdquo said Dr KewlelsquoAdults more affectedrsquoldquoMucormycosis 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 Covid19 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 Covid19 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 surgeonCase studiesPatient 1According to Dr Shetty the 6yearold 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 antifungalsPatient 2A fouryearold 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