COVID-19 associated mucormycosis in head and neck region of children during current pandemic: Our experiences

Introduction
Mucormycosis is a rare but severe fungal infection, particularly found in immunocompromised patients. Currently this dreaded mucormycosis is rising among COVID-19 paediatric patients during their treatment period or after their discharge from hospital. It is also called as black fungus. The aim of this study is to evaluate the COVID-19 associated mucormycosis (CAM) in head and neck region of the paediatric patients with its clinical manifestations and management.

Material and methods
This is a descriptive and prospective study of paediatric patients with COVID-19 associated mucormycosis (CAM) carried out at a postgraduate teaching hospital. This study was conducted between March 2020 to April 2021. Patient profile such as age, sex, comorbidities, clinical presentations, diagnosis and treatment of the CAM were analysed. There were 12 paediatric patients of CAM were enrolled in this study.

Results
Out of 12 paediatric patients of CAM, there were eight male and four female patients, aged from 3 years to 16 years. Out of the 12 patients, 3 were diabetic (25%). Three patients (25%) were taking prolonged systemic steroids with prolonged hospital ICU stay. Two children (16.66%) were under chemotherapy for acute leukaemia. The common clinical symptoms were facial swelling, facial pain, nasal block and nasal discharge. Diagnosis was confirmed by histological examination. All were treated with endoscopic surgical debridement and amphotericin B. Two patients were passed away; one was due to cerebral involvement and another was due to respiratory failure by pneumonia.

Conclusions
Early identification and prompt treatment in paediatric patients with CAM are required. Aggressive endoscopic surgical debridement for local control and appropriate systemic antifungal treatment will help to improve the prognosis and survival of the patients.