Along with the surge of coronavirus pandemic in India, there have been numerous reported cases of mucormycosis, a fungal infection that could cause blindness or serious illness and even death, among COVID-19 survivors. A growing number of cases have been reported across Gujarat and Maharashtra.
The ICMR, on Sunday, released an advisory for screening and management of the disease, listing a comprehensive list of 'do's and 'don't's.
Mathur Savani, chairman of Surat-based Kiran Super Multi-speciality Hospital, said mucormycosis patients were coming to his hospital from Surat district as well as other parts of Gujarat. "Fifty mucormycosis patients are being treated at our hospital and 60 more are awaiting [treatment]. They all came to our hospital in the last three weeks and have recovered from COVID-19 recently," Savani told PTI. Seven such patients lost eyesight, he said.
In Maharashtra, at least eight COVID-19 survivors have died due to mucormycosis while 200 others are being treated, said Dr Tatyarao Lahane, who heads the Directorate of Medical Education and Research of the state government. "They survived COVID-19, but the fungal infection attacked their weakened immune system," Dr Lahane told PTI. This disease is not new, but it is on rise among COVID-19 patients because the use of steroids elevates sugar level and some medicines suppress the immunity of these patients, he said. "In such a situation, the fungus infects the patient easily. If it reaches the brain, it can prove fatal. In one such case, one of the eyes of a patient had to be removed permanently to save his life," Dr Lahane said.
However, Niti Aayog Member (Health) V.K. Paul said on Friday that there is no "big outbreak". Paul said, "The fungal infection called mucormycosis is being found in patients of COVID-19 disease. It is caused by a fungus named mucor, which is found on wet surfaces. It, to a large extent, is happening to people who have diabetes. It is very uncommon in those who are not diabetic. There is no big outbreak and we are monitoring it."
"Mucor attacks people with uncontrolled sugar. Other than that, if the diabetes patient is taking immune suppressive medicines, steroids, or has cancer, then the impact of mucormycosis is more on that person. If these patients are exposed to wet surfaces, then the chances of getting this disease increases," he said.
Paul said drugs that suppress the immune system but are life-saving like dexamethasone, prednisolone, methylprednisolone, dexona etc., are already being used to treat COVID-19 patients.
"All these are related compounds. When these are used, the immune system gets suppressed, even in persons who are diabetic, and this fungus attacks," he said.
What is mucormycosis?
According to information in the US CDC, Mucormycosis (previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds live throughout the environment. Mucormycosis mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. It can also occur on the skin after a cut, burn, or other type of skin injury.
BBC reported that doctors believe mucormycosis may be being triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients.
The CDC notes some of the symptoms of sinus and brain mucormyosis as: One-sided facial swelling, headache, nasal or sinus congestion, black lesions on nasal bridge or upper inside of mouth that quickly become more severe and fever. Some of the symptoms of pulmonary (lung) mucormycosis included fever, cough, chest pain and shortness of breath.
ICMR advisory
The advisory is a detailed list of the black fungus, symptoms, diagnosis and other urgent measures.
'DO's
1. Control hyperglycemia.
2. Monitor blood glucose level post COVID-19 discharge and also in diabetics.
3. Use steroid judiciously—correct timing, correct dose and duration.
4. Use clean, sterile water for humidifiers during oxygen therapy.
5. Use antibiotics/antifungals judiciously.
'DON’T's
1. Do not miss warning signs and symptoms.
2. Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators.
3. Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology.
4. Do not lose crucial time to initiate treatment for mucormycosis.
Symptoms
1. Sinusitis—nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone One sided facial pain, numbness or swelling.
2. Blackish discoloration over bridge of nose/palate.
3. Toothache, loosening of teeth, jaw involvement.
4. Blurred or double vision with pain; fever, skin lesion; thrombosis and necrosis (eschar).
5. Chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms.
