New Delhi: Mucormycosis, a fungal infection being found in Covid-19 patients, may turn fatal if left untreated, the Centre said. It also issued an advisory which said that the fungal infection mainly affects people who are on medication that reduces their ability to fight environmental pathogens. The evidence-based advisory for screening, diagnosis and management of the disease by the Indian Council of Medical Research (ICMR) and the Union health ministry comes after health officials in Maharashtra and Gujarat said that cases of mucormycosis are rising among COVID-19 survivors, causing blindness or serious illness and even death in some cases. Also Read - What is Black Fungus And Can it Cause Death?

Mucormycosis: Warning sign and symptoms

  • Pain and redness around eyes and/or nose
  • Fever
  •  Headache
  • Coughing
  • Shortness of breath
  • Bloody vomits
  • Altered mental status

When to Suspect (in COVID-19 patients, diabetics or immunosuppressed individuals):

  •  Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone One sided facial pain, numbness or swelling
  • Blackish discoloration over 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, haemoptysis, worsening of respiratory symptoms

What Predisposes

  • 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
  • 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 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

How to Manage Mucormycosis

  • Control diabetes and diabetic ketoacidosis
  • Reduce steroids (if patient is still on) with aim to discontinue rapidly
  • Discontinue immunomodulating drugs
  • No antifungal prophylaxis needed
  • Extensive Surgical Debridement – to remove all necrotic materials

Medical treatment

  • Install peripherally inserted central catheter (PICC line)
  • Maintain adequate systemic hydration
  • Infuse normal saline IV before Amphotericin B infusion
  • Antifungal therapy, for at least 4-6 weeks (follow guidelines)
  • Monitor patients clinically and with radio-imaging for response and to detect disease progression