BackCentre issues advisory on management of fungal infection in Covid-19 patients
In an advisory, Centre said that mucormycosis, a fungal infection being found in COVID-19 patients with uncontrolled diabetes and prolonged ICU stay, may turn fatal if uncared for
PremiumAmid reports of detection of mucormycosis, a fungal infection, which is rising among Covid-19 survivors in India, the Centre issued an advisory on the management of this infection.
Mucormycosis is a fungal infection that mainly affects people who are on medication for other health problems that reduces their ability to fight environmental pathogens. The infection, being found in COVID-19 patients with uncontrolled diabetes and prolonged intensive care unit (ICU) stay, may turn fatal if uncared for, the Centre said.
In an advisory, it also said the fungal infection mainly affects people who are on medication that reduces their ability to fight environmental pathogens.
The evidence-based advisory for screening, diagnosis and management of the disease was released by the Indian Council of Medical Research (ICMR) and the Union health ministry.
"Mucormycosis, if uncared for, may turn fatal. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air," it said.
When to suspect (in COVID-19 patients, diabetics or immunosuppressed individuals):
Warning symptoms include pain and redness around eyes and nose, fever, headache, coughing, shortness of breath, bloody vomits and altered mental status, the advisory stated.
In COVID-19 patients with diabetes and immuno-suppressed individuals, one must suspect of mucormycosis if there is sinusitis, one-side facial pain or numbness, blackish discoloration over the bridge of the nose or palate, toothache, blurred or double vision with pain, skin lesion, thrombosis, chest pain and worsening respiratory symptoms, it said.
Major risk factors for this disease include uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, malignancy and voriconazole therapy, the ICMR-health ministry advisory stated.
How to prevent fungal infection:
To prevent the disease, blood glucose level should be monitored post-COVID discharge and also in diabetic patients; steroids should be used judiciously in correct timing, dose and duration; clean sterile water should be used in humidifiers during oxygen therapy; and antibiotics and antifungal medicines should be used correctly, it said.
The disease can be managed by controlling diabetes, discontinuing immunomodulating drugs, reducing steroids and extensive surgical debridement- to remove all necrotic materials, according to the advisory. The advisory lists the following preventive measures:
-Use masks if you are visiting dusty construction sites
-Wear shoes, long trousers, long sleeve shirts and gloves while handling soil (gardening), moss or manure
-Maintain personal hygiene including thorough scrub bath
Medical treatment includes installing peripherally inserted central catheter, maintaining adequate systemic hydration, infusion of normal saline intravenously before Amphotericin B infusion and anti-fungal therapy for at least six weeks besides monitoring the patient clinically with radio imaging for response and to detect disease progression, it said.
Here is what you can do to prevent getting infected:
-Control hyperglycemia
-Monitor blood glucose level post-COVID-19 discharge and also in diabetics
-Use steroid judiciously – correct timing, correct dose and duration
-Use clean, sterile water for humidifiers during oxygen therapy
-Use antibiotics/antifungals judiciously
Here's what you should not do:
-Do not miss warning signs and symptoms
-Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
-Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDI-TOF), for detecting fungal aetiology
-Do not lose crucial time to initiate treatment for mucormycosis
How to manage infection:
-Control diabetes and diabetic ketoacidosis
-Reduce steroids (if patient is still on) with aim todiscontinue rapidly
-Discontinue immunomodulating drugs
-No antifungal prophylaxis needed
-Extensive Surgical Debridement - to remove all necrotic materials:
i) Medical treatment
ii) Install peripherally inserted central catheter (PICCline)
iii) Maintain adequate systemic hydration
iv) Infuse Normal saline IV before Amphotericin Binfusion
v) Antifungal Therapy, for at least 4-6 weeks (see theguidelines below )
vi) Monitor patients clinically and with radio-imaging forresponse and to detect disease progression
Earlier, health officials in Maharashtra and Gujarat said that cases of mucormycosis are rising among COVID-19 survivors, causing blindness or serious illness and even death in some cases.
Mathur Savani, chairman of Surat-based Kiran Super Multi-speciality Hospital, said mucormycosis patients are coming to his hospital from Surat district as well as other parts of Gujarat.
"Fifty mucormycosis patients are being treated at our hospital and 60 more are awaiting (treatment). They all came to our hospital in the last three weeks and have recovered from COVID-19 recently," Savani told PTI.
Seven such patients lost eyesight, he said.
In Maharashtra, at least eight COVID-19 survivors have died due to mucormycosis while 200 others are being treated, said Dr Tatyarao Lahane, who heads the Directorate of Medical Education and Research of the state government.
"They survived COVID-19 but the fungal infection attacked their weakened immune system," Dr Lahane told PTI.
Amid the rise in cases of mucormycosis or 'black fungus' infection among COVID-19 survivors, the Gujarat government has started setting up separate wards in hospitals for such patients and has procured 5,000 vials of a medicine used in its treatment.
Gujarat has so far reported over 100 cases of mucormycosis, a serious but rare fungal infection which has left many patients blind and is also causing other serious issues.
Currently, 19 patients are undergoing treatment for it at the Ahmedabad Civil Hospital, as per the state government.
With inputs from PTI
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