Cases of mucormycosis, a fungal infection, are rising among Covid-19 survivors, causing blindness or serious illness and even death in some cases. The cost of treatment for this disease is also a matter of concern, some doctors said.
Amid the rise in cases of mucormycosis or ‘black fungus’ infection cases, the government released an evidence-based advisory for screening, diagnosis, and management of the disease.
What is mucormycosis?
According to the government, mucormycosis is a fungal infection that mainly affects people who are medication that reduces their ability to fight environmental pathogens. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air. The guideline was prepared by the Union Health Ministry and ICMR that have been in the frontline of the government’s war against the coronavirus pandemic.
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The government also shared a link (https://www.ijmr.org.in/temp/IndianJMedRes1392195 -397834_110303.pdf) for detailed management guideline followed globally, which is an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium.
This can lead to serious disease with the following warning sign and symptoms:
- Pain and redness around eyes and/or nose
- Fever
- Headache
- Coughing
- Shortness of breath
- Bloody vomits
- Altered mental status
PREDISPOSITION
- Uncontrolled diabetes mellitus
- Immunosuppression by steroids
- Prolonged ICU stay
- Co-morbidities – post-transplant/malignancy
- Voriconazole therapy
DOS
- Control hyperglycemia
- Monitor blood glucose level post-Covid-19 discharge and also in diabetics
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- Use steroid judiciously – correct timing, correct dose, and duration
- Use clean, sterile water for humidifiers during oxygen therapy
- Use antibiotics/antifungals judiciously
DON’TS
- Do not miss warning signs and symptoms
- Do not consider all the cases with a blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or Covid-19 patients on immunomodulators
- Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology
- Do not lose crucial time to initiate treatment for mucormycosis
PREVENTIVE MEASURES
- Use masks if you are visiting dusty construction sites
- Wear shoes, long trousers, long sleeve shirts, and gloves while handling soil (gardening), moss, or manure
- Maintain personal hygiene, including thorough scrub bath
WHEN TO SUSPECT
- Sinusitis – nasal blockage or congestion, nasal discharge (blackish/bloody), local pain on the cheekbone One-sided facial pain, numbness or swelling
- Blackish discoloration over the bridge of nose/palate
- Toothache, loosening of teeth, jaw involvement
- Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
- Chest pain, pleural effusion, hemoptysis, worsening of respiratory symptoms
MANAGEMENT OF MUCORMYCOSIS
- Control diabetes and diabetic ketoacidosis
- Reduce steroids (if the patient is still on) with the aim to discontinue rapidly
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- Discontinue immunomodulating drugs
- No antifungal prophylaxis needed
- Extensive Surgical Debridement - to remove all necrotic materials
- Medical treatment
i) Install peripherally inserted central catheter (PICC line)
ii) Maintain adequate systemic hydration
iii) Infuse normal saline IV before Amphotericin B infusion
iv) Antifungal therapy, for at least 4-6 weeks (follow guidelines)
v) Monitor patients clinically and with radio-imaging for response and to detect disease progression
