Black fungus: ICMR releases guidelines; Dos and don'ts
According to doctors, cases of mucormycosis are being seen among Covid patients who were administered steroids to treat symptoms, and particularly among those who are suffering from diabetes and cancer.
Amid rising cases of mucormycosis or "black fungus" infection among COVID patients, the Centre has released guidelines on dos and don'ts for the patients. The Centre has also asked doctors to look out for signs of the rare but potentially fatal infection in Covid-19 patients.
The Indian Council of Medical Research (ICMR) has released guidelines for early detection of infection. It has advised that after recovering from coronavirus infection, patients or their caretaker should closely monitor and should not miss any warning signs and symptoms mentioned above, as the fungal infection is found to emerge even weeks or months after recovery.
It also asked people to continue to wear masks while visiting dusty construction sites or crowded place, wearing shoes, long trousers, long sleeve shirts and gloves while gardening, moss or manure and to maintain personal hygiene including thorough scrub baths to stave off the infection.
According to doctors, cases of mucormycosis are being seen among Covid patients who were administered steroids to treat symptoms, and particularly among those who are suffering from diabetes and cancer. Mucormycosis begins to manifest as a skin infection in the air pockets located behind the forehead, nose, cheekbones and in between the eyes and teeth. It then spreads to the eyes, lungs and can even spread to the brain. It leads to blackening or discoloration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing of blood.
The treatment of this infection requires a multi-disciplinary approach consisting of eye surgeons, ENT specialists, general surgeons, neurosurgeons and dental maxillofacial surgeons, among others, and the institution of the Amphotericin-B injection as an antifungal medicine.
Covid patients with 'high risk' to get infected by black fungus
- Uncontrolled diabetes
- Patients on high dose steroids and/or long duration of steroids or tocilizumab
- Weakening of immune system due to use of steroids
- Patients on oxygen support—nasal prongs, by mask, or on a ventilator
- Prolonged ICU/hospital stay
- Co-morbidities / post organ transplant / cancer
- Voriconazole therapy (used to treat serious fungal infections)
Medical experts have pointed to strong links between diabetes and infection. Also, Covid-19 has a tendency to worsen diabetes and also precipitate diabetes in previously normal individuals. Patients' relatives or caretakers are advised to help the patient consciously conduct regular self-examinations.
What are the typical set of symptoms of Mucormycosis:
- Abnormal black discharge or crusty dryness, or bleeding from the nose
- Nasal blockage
- Headache or eye pain
- Swelling around the eyes, double vision, redness of the eye, loss of vision, difficulty in the closing eye, inability to open the eye, prominence of the eye
- Facial numbness or tingling sensation, difficulty in chewing or opening the mouth
Mucormycosis -- Dos
- Control hyperglycemia or high blood sugar levels
- Monitor blood glucose level post-COVID-19 discharge and also in diabetics
- Use steroid judiciously
- Use clean, sterile water for humidifiers during oxygen therapy
- Use antibiotics/antifungals judiciously
Mucormycosis -- Don'ts
- 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, MALDITOF), for detecting fungal etiology
- Do not lose crucial time to initiate treatment for mucormycosis
Earlier, Health Minister Harsh Vardhan has advised people on the early detection and management of the black fungal infection. He suggested patients to not self-medicate with steroids or delay reporting symptoms of the infection. The minister also tweeted a handy infographic on the guidelines for Mucormycosis.
Meanwhile, the Union Health Ministry has urged the states and Union territories to make black fungus or mucormycosis a notifiable disease under the Epidemic Diseases Act, 1897, stating that the infection is leading to prolonged morbidity and mortality among Covid patients.
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