Patient: [Patient Name]
Date: [Date of Encounter]
I. Chief Complaint:
Fever (temperature)
Cough (productive, may be bloody)
Shortness of breath (dyspnea) – often worsening
Chest pain (pleuritic)
Other symptoms (fatigue, weight loss)
II. History of Present Illness:
Onset and duration of symptoms
Progression of symptoms (especially worsening dyspnea)
Recent hospitalization for COVID-19 (confirmed or suspected)
Underlying medical conditions (diabetes mellitus most important)
Immunocompromised state (if applicable)
Use of corticosteroids during COVID-19 treatment
III. Past Medical History:
Diabetes mellitus (type 1 or 2) – controlled or uncontrolled
History of other fungal infections
Previous surgeries (especially chest or sinus surgery)
IV. Medications:
Current medications (including corticosteroids, antifungals if started)
V. Social History:
Recent travel history (mucormycosis is more common in some regions)
VI. Vital Signs:
Blood pressure (BP)
Heart rate (HR)
Respiratory rate (RR)
Oxygen saturation (SpO2) – may be low despite supplemental oxygen
VII. Physical Exam:
General appearance (illness severity, signs of malnutrition)
Respiratory exam:
Rate and depth of respirations
Use of accessory muscles
Chest auscultation (rales, wheezing)
VIII. Diagnostic Studies (consider as appropriate):
Imaging studies:
Chest X-ray (may show infiltrates, nodules, cavitation)
Chest CT scan (preferred modality) – may show characteristic features of invasive fungal pneumonia with angioinvasion
Microbiology:
Sputum culture (may not be diagnostic)
Bronchial washings with fungal culture and biopsy (preferred for definitive diagnosis)
Laboratory tests:
Serum fungal markers (β-D-glucan, galactomannin) – may be helpful but not diagnostic
IX. Assessment:
Suspected COVID-19-associated pulmonary mucormycosis based on clinical presentation, history of COVID-19, underlying medical conditions, and imaging findings.
Severity of illness (consider respiratory failure, hemodynamic instability)
Diagnostic confirmation pending – fungal culture and/or biopsy results are crucial.
X. Plan:
Urgent antifungal therapy: Broad-spectrum antifungal medication (often liposomal amphotericin B) should be initiated while awaiting definitive diagnosis due to high mortality associated with mucormycosis.
Management of underlying conditions (strict glycemic control in diabetes)
Respiratory support (supplemental oxygen, mechanical ventilation if needed)
Corticosteroid tapering (if feasible) – important to balance immunosuppression with COVID-19 management
Definitive diagnosis with bronchoscopy with fungal culture and possible biopsy.
Surgical debridement of necrotic tissue (may be necessary in some cases)
XI. Prognosis:
Discuss the serious nature of mucormycosis and the importance of prompt diagnosis and treatment.
Prognosis depends on severity of fungal infection, underlying medical conditions, and immune status.
XII. Notes:
Include any additional observations or concerns, such as response to antifungal therapy, need for intensive care consultation, and communication with the provider who managed the patient’s COVID-19 illness.
XIII. Resources:
Consider providing patient education materials on mucormycosis from reputable sources (e.g., Centers for Disease Control and Prevention (CDC), Infectious Diseases Society of America (IDSA)).
XIV. Disclaimer:
This template provides a general framework for a COVID-19-associated pulmonary mucormycosis progress note. The specific content of the note will vary depending on the individual patient and the findings. Early diagnosis and prompt treatment are critical for improving outcomes in this life-threatening condition.