Mucormycosis treatment challenges, oxygen therapy link: Top doctor lists out
Gujarat and Maharashtra are among the 18 states which have reported more than 5000 cases of mucormycosis or black fungus as the country battles the massive second wave of the coronavirus disease (Covid-19). According to Union health minister Dr Harsh Vardhan, Gujarat reported 2165 cases, Maharashtra 1188, Uttar Pradesh 663, Madhya Pradesh 590, Haryana 339 and Andhra Pradesh 248 cases. "Out of these 5424 cases of mucormycosis, we have seen that 4556 cases have a history of Covid-19 infection, while 875 cases are amongst non-Covid patients. Diabetes was present in 55 percent of the patients,” the health minister said at the 27th group of ministers (GoM) meeting on Covid-19 on Monday.
"We have been warning, issuing advisories and, through our experts, it has been communicated that indiscriminate use of steroids must be avoided and diabetes must be treated thoroughly as best as possible," he said. “Nine lakh vials of Amphotericin-B are being imported by the central government for the treatment of black fungus. Of this, 50,000 vials have been received and around 300,000 vials will be available in the next seven days," he said.
Nineteen states have already declared mucormycosis a notifiable disease under the epidemics act and will now have to be reported to government authorities.
What is mucormycosis?
Mucormycosis is a deadly and aggressive fungal infection that causes blackening or discolouration over the nose, one-sided facial swelling, headache, nasal or sinus congestion, fever, blurred or double vision, chest pain, breathing difficulties and coughing blood. The disease has a close link to diabetes and conditions which compromise the immune system of the human body. According to experts, an overuse during the Covid-19 pandemic of certain drugs which suppress the immune system could be causing the surge.
Mucormycosis has a mortality rate of 54%, which can vary depending on the condition of the patients and the body part affected, data from the US Centers for Disease Control and Prevention shows.
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Not a communicable disease
Dr Randeep Guleria, the director of Delhi’s All India Institute of Medical Science (AIIMS), said on Monday the number of cases of mucormycosis is being reported is on the rise but it is not a communicable disease and does not spread from one person to another, like Covid-19 does.
Dr Guleria also cautioned against using the term black fungus while talking of mucormycosis, as it leads to a lot of avoidable confusion. “Black fungus is another family; this term got associated with mucormycosis due to the presence of black dots among the culture of white fungal colonies. In general, there are various types of fungal infections such as candida, aspergillosis, cryptococcus, histoplasmosis and coccidioidomycosis. Mucormycosis, candida and aspergillosis are the ones observed more in those with low immunity,” he said during a press briefing.
“Candida fungal infection can manifest with symptoms such as white patches in the mouth, oral cavities and tongue; it can infect private parts and can also be found in the blood (in which case it can become serious). Aspergillosis, which is relatively not common, affects and invades lungs by creating cavities in the lungs. What is observed in Covid-19 is mostly mucormycosis; aspergillosis is observed occasionally, and Candida in some people.”
“Ninety to ninety-five per cent of patients getting infected with mucormycosis are found to have been either diabetic and/or taking steroids. This infection is seen very rarely in those who are neither diabetic nor taking steroids,” Guleria said.
He also said that patients who are under high-risk category, those with uncontrolled diabetes and using steroids and are Covid-19 positive, with following symptoms should immediately report them to their doctors. “Some warning signs for mucormycosis such as headache, rusting or bleeding from nose, swelling below the eye, lowering of facial sensation, if observed in high-risk patients or those taking steroids, need to be informed to doctors so that early diagnosis and treatment can be given,” he said.
No definite link with oxygen therapy
“Many patients taking treatment at home, who were not on oxygen therapy, have also been found to get infected with Mucormycosis. So there is no definite link between oxygen therapy and catching the infection,” Dr Guleria added.
Anti-fungal treatment goes on for many weeks so it is proving to be challenging for hospitals as Covid-19 patients and other patients who get mucormycosis need to be housed in separate hospital wards. Surgery also needs to be done judiciously since aggressive surgery for mucormycosis can have adverse outcomes for Covid-19 patients.
Maintaining proper hygiene is very important for diabetic patients since chances of opportunistic infection is very high in them, experts have said. They have also said that those using oxygen concentrators should ensure cleaning of humidifiers regularly.
Types of mucormycosis
Mucormycosis can be categorised depending on the organ of the human body it attacks. Signs and symptoms of the infection also vary depending on the affected body part.
Rhino orbital cerebral mucormycosis: It infects the nose, orbit of eye / eye socket, oral cavity and can even spread to the brain. Symptoms include headache, nasal congestion, nasal discharge (green colour), pain in sinus, bleeding nose, swelling on face, lack of sensation on face and skin discolouration.
Pulmonary mucormycosis: This fungal infection affects the lungs and causes fever, chest pain, cough and coughing of blood.
The fungus can also infect the gastrointestinal tract.