Indian Journal of Dental Research

EDITORIAL
Year
: 2021  |  Volume : 32  |  Issue : 1  |  Page : 2-

Dental surveillance for Post-COVID mucormycosis


SM Balaji 
 Executive Editor, Indian Journal of Dental Research, Department of Oral and Maxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India

Correspondence Address:
S M Balaji
Executive Editor, Indian Journal of Dental Research, Department of Oral and Maxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu
India




How to cite this article:
Balaji S M. Dental surveillance for Post-COVID mucormycosis.Indian J Dent Res 2021;32:2-2


How to cite this URL:
Balaji S M. Dental surveillance for Post-COVID mucormycosis. Indian J Dent Res [serial online] 2021 [cited 2021 Aug 4 ];32:2-2
Available from: https://www.ijdr.in/text.asp?2021/32/1/2/321377


Full Text



All spheres of activities of the world have been severely affected by the COVID-19 pandemic. While in the early phases of the pandemic, meeting health emergencies of the COVID-19 affected patient assumed importance. With the receding first wave, providing vaccination assumed priority. At the same time, there was some peculiar post-COVID-19 complication reported, some of which were termed as “long-term COVID-19”.[1]

In the post-COVID-19 scenario, oral fungal infections were being increasingly reported. Of such infections, the most reported were the mucormycosis, aspergillosis, and candidiasis.[2],[3],[4],[5] Of this, the former two are pathological entities whereas the latter is a normal oral commensal.[5] The cause for the spurt of fungal infection has been attributed to use of steroids, possibility of altered blood sugar levels, and persistent increased pro-inflammatory markers, such as interleukin (IL)-1, IL-6, and tumor necrosis alpha in COVID-19 patient. Also they have relatively less CD4 interferon-gamma expression, fewer CD4 and CD8 cells. Together owing to the reduced immune suppression and ease of noso-comial spread of such infection, these infections turn severe.

The algorithm for dental management of post-COVID-19 cases has been reported.[6] The chance of having significant, undiagnosed medical, physiological, and neurological residual effects or effects of long COVID-19 has to be borne in mind before the patient with history of COVID-19 is taken.

A dentist would need to investigate any unexplained swelling, ulcers or swellings, or patches of short duration, especially in post-COVID-19 patients who were on steroids for longer duration and whose blood sugar levels are exceptionally high.[7] History regarding associated clinical signs for high blood sugar, such as tiredness, recent loss of weight, polydipsia, and polyuria should be asked in proper way. In case of any suspicion, the lesion must be investigated with radiology or pathologically at the earliest. When diagnosed and treated early with antifungal drugs, the prognosis is better. If diagnosed or treated later, the chance of morbidity or mortality is high. The removal of affected oral tissue should be done immediately under antifungal coverage. Reconstruction, though a challenge can be effectively done later.

Hospital outbreaks and emergence of Candida auris, especially drug-resistant strains have been reported in COVID-19 treatment units.[8] If the organism escapes surveillance and spreads, the effects can be disastrous. Hence, dentists should be alert and look for any fungal infections in post-COVID-19 patients. He or she should exert maximum effort to diagnose the condition and effectively treat the post-COVID-19 patients for orofacial fungal infection.

References

1Evert K, Dienemann T, Brochhausen C, Lunz D, Lubnow M, Ritzka M, et al. Autopsy findings after long-term treatment of COVID-19 patients with microbiological correlation. Virchows Arch 2021:1-12. doi: 10.1007/s00428-020-03014-0.
2Balaji SM. Post COVID-19 fungal and microbial infections. Indian J Dent Res 2020;31:669.
3Sai Krishna D, Raj H, Kurup P, Juneja M. Maxillofacial infections in Covid-19 era-actuality or the unforeseen: 2 case reports. Indian J Otolaryngol Head Neck Surg 2021:1-4. doi: 10.1007/s12070-021-02618-5.
4Rajendra Santosh AB, Muddana K, Bakki SR. Fungal infections of oral cavity: Diagnosis, management, and association with COVID-19. SN Compr Clin Med 2021:1-12. doi: 10.1007/s42399-021-00873-9.
5Riad A, Gomaa E, Hockova B, Klugar M. Oral candidiasis of COVID-19 patients: Case report and review of evidence. J Cosmet Dermatol 2021;20:1580-4.
6Chakraborty T, Jamal RF, Battineni G, Teja KV, Marto CM, Spagnuolo G. A review of prolonged post-COVID-19 symptoms and their implications on dental management. Int J Environ Res Public Health 2021;18:5131.
7Pilato VD, Codda G, Ball L, Giacobbe DR, Willison E, Mikulska M, et al. Molecular epidemiological investigation of a nosocomial cluster of C. auris: Evidence of recent emergence in Italy and ease of transmission during the COVID-19 pandemic. J Fungi 2021;7:140.
8Bardi T, Pintado V, Gomez-Rojo M, Escudero-Sanchez R, Lopez AA, Diez-Remesal Y, et al. Nosocomial infections associated to COVID-19 in the intensive care unit: Clinical characteristics and outcome. Eur J Clin Microbiol Infect Dis 2021;40:495-502.