Post-Covid complications rise at AIIMS Patna as new cases go down in Bihar

There was a significant rise in patients with post-Covid fibrosis and “fibrosis-like changes” that may regress with time, depending on the severity of scarring, said a senior doctor at AIIMS Patna.

Number of patients with post-Covid pulmonary cavitation or cavity in the lungs and lung fibrosis or irreversible scarring in the lungs is increasing at All India Institute of Medical Sciences (AIIMS)-Patna, a designated centre of excellence (CoE) for clinical management of the pandemic in Bihar.

All India Institute of Medical Sciences (AIIMS)-Patna, is a designated centre of excellence (CoE) for treatment of Covid-19. (HT Photo)

“We have already got 30-40 cases of post Covid pulmonary cavitation in the last two months,” said Dr Deependra Kumar Rai, additional professor and head, department of pulmonary medicine at AIIMS-Patna.

Such cases mostly show symptoms like persistent cough, chest pain, dyspnea (breathlessness) or hemoptysis (blood in sputum). Patients may have fever with oxygen saturation around the threshold level of 94.

Additional professor and head, department of medicine, AIIMS-Patna, Dr Ravi Kirti, said there is a significant rise in patients with post-Covid fibrosis and “fibrosis-like changes” that may regress with time, depending on the severity of scarring.

“Patients with post-Covid chest infection, whose oxygen saturation still drops below the threshold limit or those having dry cough and reduced exercise tolerance are increasing. We generally suggest a chest X-ray, sometimes followed by a chest CT scan and spirometry before deciding on further treatment,” said Dr Kirti.

Cases of post-Covid pulmonary cavitation are often diagnosed as tuberculosis (TB) and Dr Rai advocates bronchoscopy investigation, especially in case of patients who cannot expectorate phlegm, before prescribing anti-TB drugs or antibiotics to the patient.

“Patients are generally referred to us after they have been administered a strong dose of antibiotics, which is ineffective in such cases,’’ said Dr Rai, who is researching on post-Covid pulmonary cavitation.

During his research, Dr Rai found that five of the six patients in his sample study had contracted aspergillosis fungal infection while one was a mucormycosis (black fungus) suspect.

Dr Rai, however, said the prohibitive pricing of Voriconazole is a deterrent in the treatment of poor patients suffering from aspergillosis fungal infection.

“Each tablet costs around ₹850 in the open market, but the same is available for one-third the market rate at AIIMS. We generally prescribe it twice a day for nearly three months to our patients. The government should include some such drugs related to Covid-19 and post-Covid ailments in its essential drug list and supply them to patients through its channel,” said Dr Rai.

The AIIMS has played a significant role in the treatment of Covid-19 and post-Covid ailments, including mucormycosis, in the state. Its team of experts, led by additional professor of ENT, Dr Kranti Bhawna, has operated over 100 cases of black fungus.

As many as 6,346 Covid-19 patients and suspects have undergone treatment at AIIMS-Patna since March 20 last year, when the state reported its first Covid-19 case. The institute has treated 5,650 patients, with a recovery rate of nearly 80%, after it set up dedicated Covid wards in May 2020, according to Dr Sanjeev Kumar, Covid-19 nodal officer of the institute.

Around 1,437 Covid-19 patients were admitted to AIIMS-Patna between April and May, the peak of the second pandemic that saw 29% of the total Covid deaths with 377 out of the total 1,291 patients dying due to Covid-19 at the institute.

“July 10 was the first day since the second wave of the pandemic that no sample out of the 2,217 collected for real-time polymerase chain reaction test tested positive,” said Dr Kumar.

From 15,853 new infections and 82 deaths on May 1, the number of new Covid cases and deaths has come down to 87 and two, respectively, on July 10. As many as 1,233 cases and 23 deaths have been reported this month against 723,147 cumulative Covid-19 cases and 9,618 deaths so far in the state.