Maharashtra issues guidelines for handling rising mucormycosis cases
Taking cognisance of the rise in cases of mucormycosis, also known as black fungus, among recovered Covid-19 patients, the Maharashtra government on Monday issued detailed guidelines over its symptom, medical investigation, prevention and treatment protocol. The state has asked for strict glycemic control during management of Covid-19 patients which means blood sugar levels must be continuously controlled for all patients while systemic steroids are to be used only in patients with hypoxemia.
The guidelines have been issued to reduce morbidity and fatality among mucormycosis patients as the state believes its occurrence is triggered by the use of high doses of steroids to treat Covid-19 and in uncontrolled diabetes cases.
The guidelines include strict infection control measures including cleaning and replacement of humidifiers. It states that sterile normal saline should be used in the humidifier bottle and changed daily and masks should be disinfected daily. “Local public health laboratories should be asked to take swabs of humidifiers, masks, tubing and common touch areas for culture of mucormycosis,” stated the order issued by Ramaswami N, commissioner, health services and mission director, National Health Mission (NHM), Maharashtra.
Doctors have been asked not to miss warning signs and symptoms and also not to consider all cases of blocked nose as cases of bacterial sinusitis, especially in the context of immunosuppression and Covid-19 patients on immunomodulators, it further said.
It also described signs and symptoms of mucormycosis comprising pain and redness around eyes and nose, fever (usually mild), epistaxis (bleeding from the nose), headache, cough, shortness of breath, blood vomiting and altered mental status.
“During discharge of the patients, advice about early symptoms or signs of mucormycosis such as facial pain, blockage, excessive discharge, loosening of teeth, chest pain and respiratory insufficiency,” it added.
Maharashtra has over 400 cases of mucormycosis with around eight to 10 fresh cases daily. “We are getting a few cases of black fungus, around 8 to 10 cases, on a daily basis. On Sunday, around 14 cases were reported across the state,” said Dr Tatyarao Lahane, director, Directorate of Medical Education and Research (DMER).