‘Follow-up on recovered Covid-19 patients with diabetes, kept on oxygen for over a week’
With the growing cases of mucormycosis in the city, the Brihanmumbai Municipal Corporation (BMC) has instructed hospitals to follow-up with Covid-recovered, diabetic patients for symptoms of the black fungal infection. These also include patients who have been on oxygen therapy or in intensive care units (ICU) for more than seven days.
Mucormycosis is a serious but rare fungal infection caused by a group of moulds called mucormycetes. According to doctors, it causes blindness, organ dysfunction, loss of body tissue and can be fatal if not treated on time.
“We have been instructed to screen a sizeable number of Covid-19 patients with high sugar or diabetes before they get discharged from the hospital. Additionally, we are also following-up with such patients after their discharge if they have developed symptoms such as headache, black discharge from nose, among others,” said Dr Ramesh Bharmal, dean of BYL Nair Hospital.
As per doctors, oxygen therapy for a long duration causes exposure to humidified air. If the water in the humidification is not sterilised, it exposes sinuses to the infection.
“This makes patients on oxygen therapy for a long time vulnerable to acquiring the infection. Also, patients with cardio-pulmonary complications in ICUs develop lower immunity to contract the fungal infection later,” said Dr Bharmal.
Compared to last year, the number of mucormycosis cases has increased in the second wave. Since the beginning of the second pandemic in February, over 170 Covid-recovered patients have contracted mucormycosis in the city. Out of these, 24 of them lost their lives to the infection.
“The directive has been given for the early detection of the cases. It has been observed that patients often ignore their symptoms as post-Covid issues, which often delays the diagnosis. Due to this, the fungi become more aggressive and kill tissues inside the nose, throat, palate, sinus and even brain which causes death,” said Dr Mohan Joshi, dean of Lokmanya Tilak General Hospital (Sion hospital).
According to a guideline issued on May 17 by the state’s commissioner of health services and mission director, National Health Mission, if required, patients with high sugar need to be examined by an ENT (ears, nose, throat) specialist for symptoms of mucormycosis. Patients can also be examined by an ophthalmologist, if needed.
“The immunity in a Covid-19 patient gets compromised due to some medicines such as Tocilizumab and steroids. So, when they get exposed to mucor mold – commonly found in soil, plants, manure and decaying fruits and vegetables – it becomes life-threatening. It affects the sinuses, the brain and the lungs,” said Dr Girija Suresh, senior ophthalmic consultant, Fortis Hospital, Mulund.
Steroids reduce inflammation in the lungs of Covid-19 patients. But it also reduces immunity and increases the blood sugar levels in Covid-19 patients.
Dr Ajay Doiphode, president, Association of Otolaryngologists, attributed unregulated usage of steroids, which lowers the immunity in the body, as one of the primary reasons for the surge in cases of mucormycosis.