There is rise in cases of mucormycosis, or the black fungal infection in states like Maharashtra and Delhi. Due to this, the Union Health Ministry has issued a list of do’s and don’ts for the recovered Covid patients who are experiencing the symptoms.
WHAT IS MUCORMYCOSIS / BLACK FUNGAL INFECTION?
Mucormycosis is a complication which is caused by fungal infection. The person catches mucormycosis when the person comes in contact with fungal spores in the environment.
A cut, scrape, burn, or other type of skin trauma are other reasons related to the development of black fungus on the skin. This infection is being detected from the patients who have recovered or are recovering from Covid-19.
As per the advisory issued by Indian Council of Medical Research, the following conditions in Covid-19 patients increase the risk of mucormycosis infection:
- Uncontrolled diabetes
- Weakening of immune system due to use of steroids
- Prolonged ICU/hospital stay
- Comorbidities/post organ transplant/cancer
- Voriconazole therapy (used to treat serious fungal infections)
DO’S :
- Control hyperglycaemia
- Monitor blood glucose level post Covid discharge and in diabetes.
- Using steroid judiciously
- Using clear and sterile water for humidifiers during oxygen therapy.
- Using antibiotics/antifungal judiciously.
DON’TS:
- Ensure that you don’t miss warning signs and symptoms.
- Do not consider all cases of blocked nose as cases of bacterial sinusitis, specially in the cases of immunosuppression and/or Covid patients on immunomodulators.
- Ensure that you seek aggressive investigations as appropriate for detecting fungal etiology.
- Don’t lose crucial time to initiate treatment for mucormycosis.
RELATION TO COVID-19
This infection is caused by a set of microorganisms known as mucormycetes and they are naturally present in the environment. They are mostly seen in soil and in decaying organic matter like leaves, compost and piles.
Normally, our body is immune to fight with such infections, but the Covid-19 affects our immune system. The treatment of patients of Covid-19 involves intake of drugs like dexamethasone, which suppress our immune system response. Because of this, the patients face risk of failing the battle against mucormycetes.
Moreover, the Covid patients who undergo oxygen therapy in the ICU where the humidifiers are used, they are prone to fungal infection due to the exposure to moisture.
However, not every patient gets infected by Mucormycosis. This infection is uncommon in the ones who do not have diabetes but it can prove to be fatal if it is not treated promptly.
COMMON SYMPTOMS
The infection begins to manifest as a skin infection in the air pockets which are behind our forehead, nose, cheekbones and in between our eyes and teeth. Later, it spreads to eyes, lungs and even to the brain.
It causes blackening or discoloration over the nose, double or blurred vision, chest pain, breathing difficulties and coughing of blood.
Indian Council of Medical Research advises that not all cases of blocked nose should be considered as case of bacterial sinusitis, particularly during/after the treatment of Covid-19 patients. Medical help must be seeked to detect fungal infections.
TREATMENT
The infection might just begin with skin infection, but it can even spread to other parts of the body. The treatment for this infection involves removing all dead and infected tissue through surgical methods. In some cases, it may even result in the loss of upper jaw or even the eye.
The treatment may also involve a 4-6 weeks course of intravenous anti-fungal therapy. As the infection affects various parts of the body, the cure requires a team of microbiologists, internal medicine specialists, intensivist neurologists, ENT specialists, ophthalmologists, dentists, surgeons and others.
One of the foremost prevention suggested by the ICMR is to control diabetes. The Covid-19 patients who are diabetic need to take utmost care.
Talking about the adverse effects of inappropriate use of steroids, Niti Aayog member Dr V K Paul says: “Steroids should never be administered at an early stage of Covid-19. They should be taken only after sixth day of infection. Patients should stick to appropriate doses of the drugs and take the drug for specific number of days as advised by the doctors. Rational use of medicines should be ensured to avoid adverse side effects of the drug.”
“Other than steroids, use of Covid-19 drugs such as Tocilizumob, Itolizumab also suppresses the immune system. And when these drugs are not used appropriately, it increases the risk, as our immune system fails to fight the fungal infection.” Dr Paul adds.
For the oxygen therapy, it must be ensured that water in the humidifier is clean and is refilled regularly. Full attention must be paid in order to ensure that there is no leakage of water. This should be done to ensure that there is no wet surface where the fungus can breed.
