Surge in mucormycosis cases: Maharashtra sets up task force

In view of a three to four times surge in mucormycosis or black fungal infection amid increase in recovered Covid-19 patients in the ongoing second wave, the Brihanmumbai Municipal Corporation (BMC) has created an internal advisory board consisting of head of the department of ENT, ophthalmology, medicine, anaesthesia from various medical colleges in the city

In view of a three to four times surge in mucormycosis or black fungal infection amid increase in recovered Covid-19 patients in the ongoing second wave, the Brihanmumbai Municipal Corporation (BMC) has created an internal advisory board consisting of head of the department of ENT, ophthalmology, medicine, anaesthesia from various medical colleges in the city. Suresh Kakani, additional commissioner, BMC, said the state public health department has formed a separate task force to look into the matter of mucormycosis in the state.

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Since February, five major government and civic-run hospitals have recorded 151 cases of mucormycosis in recovered Covid-19 patients. Mucormycosis is a serious but rare fungal infection caused by a group of mould called mucormycetes. It causes blindness, organ dysfunction, loss of body tissue and even death if not treated on time, said doctors.

“The board will investigate each case like probable source of infection, line of treatment if the patient needs infection or debridation (medical removal of dead, damaged, or infected tissue), procurement of the medicines and post-recovery treatment,” said Kakani.

“In Covid-19 patients, immunity gets compromised due to some medicines like Tocilizumab and steroids. When they get exposed to mucor mould, which is commonly found in soil, plants, manure, and decaying fruits and vegetables, it becomes life threatening. It affects sinuses, brain and lungs,” said Dr Girija Suresh, senior ophthalmic consultant, Fortis Hospital, Mulund.

Surge in cases in second wave

Though no cumulative data is available for last year, doctors from both private and government hospitals have witnessed a drastic rise in mucormycosis cases in the second wave which started in February.

At Fortis Hospital, doctors have observed a three-time rise in cases. Similarly, Dr Amol Patil, senior consultant, ENT and skull-base surgery at Nanavati Max Super Speciality Hospital, said while they treated five patients with mucormycosis last year, the number of cases since February this year has increased to around 15.

“Most patients are within the age group of 30-50 years who came with sinus infection. In patients with advanced infection, we observed eye involvement causing vision loss and spread of the infection to the brain, with life-threatening sequelae (secondary infection). We are seeing more cases now as compared to last year, but we need thorough clinical studies to fully understand the reasons,” said Dr Patil.

Of the 151 mucormycosis cases recorded in the second wave in the city, King Edward Memorial (KEM) Hospital, Lokmanya Tilak General Hospital also known as Sion hospital, BYL Nair, Sir JJ Hospital and RN Cooper Hospital have recorded 34, 32, 38, 40 and seven cases, respectively.

Dr Mohan Joshi, dean of Sion hospital, said they were receiving one or two cases per month in the first wave of the pandemic which has now increased to seven to eight per month.

Doctors believe the actual number could be higher.

Dr Ajay Doiphode, president, Association of Otolaryngologists (AOI) Mumbai Branch and Mumbai ENT Association, said there is no proper system of data collection, and therefore many cases may have gone undocumented.

Steroids reduce inflammation in the lungs of Covid patients, but it also reduces the immunity and increases the blood sugar levels. Dr Doiphode attributed unregulated usages of steroids that lower immunity as one of the primary reasons for the surge in cases.

“When ICMR declared that steroids are helpful in the treatment of Covid-19, doctors blindly started prescribing the steroids. Patients with mild symptoms who took treatment at home are given steroids. This unregulated usage needs to be stopped,” he said.

Prevention better than cure

With early detection of cases, a patient’s organs and tissues can be saved from getting surgically removed. A patient in his early stage of infection can be treated with anti-fungal injections such as Liposomal Amphotericin B injection.

Dr Doiphode said, “The doses depend on the weight of the patient. Per kilogram, we administer 5mg. But in more serious cases, we increase it further. We also have another anti-fungal medicine, Posaconazole, which is given post recovery.” With this, doctors also need to monitor the kidney.

But if a patient is detected at a later stage, doctors have to debride the infected tissues and organs. At Sion hospital, 11 patients have lost their eyes and six of them succumbed to the infection, as per Dr Renuka Bradoo, head of the hospital’s ENT department. “Most of the patients were middle aged with the medical history of diabetes,” she added.

With the rise in the cases, the city is witnessing a shortage of Liposomal Amphotericin B injection. As per doctors, each patient needs five to six injections per day.

Dr Bharmal said BMC has floated a tender to procure 190,000 of the life-saving injection and 38,000 Posaconazole tablets.

“They need to fasten the procurement process or else, more patients will die,” said Dr Doiphode.

Patients suffering from the fungal infection normally have stuffy nose. Sometimes, blood may ooze out of the nose. They might have swelling and pain in the eye along with drooping of eyelids and blurred eye vision. There could be black patches of skin around the nose.

Dr Suresh said the only way to reduce the possibility of fungal infection is to administer right doses of steroids. “The patients, even after recovery, should follow up with doctors. It is also important to maintain hygiene after getting discharged from hospitals,” she said.