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The Centre on Sunday said that Mucormycosis is a fungal infection found in COVID patients with uncontrolled diabetes and prolonged ICU stay and added that it may turn fatal if uncared.

Corona patients with diabetes and low immunity powered people must suspect of black fungal infection if there is one-side facial numbness or pain, sinusitis, blackish discolouration over the nose, blurred vision, toothache, thrombosis, chest pain, skin lesion.

Mucormycosis: Gujarat sets up special wards in hospitals
source: www.freepressjournal.com

As per the advisory, Mucormycosis mainly affects the people who are on medication which reduces the ability to fight against the pathogens. It said that the uncared Mucormycosis may turn fatal. Lungs or sinuses of such persons will get affected after inhaling the fungal spores from the air. The advisory stated that the symptoms of Mucormycosis are pain and redness around the eyes and nose, headache, fever, vomiting and difficulty in breathing.

credit: Twitter

This can lead to serious disease with warning signs and symptoms such as:

  • Pain and redness around eyes and/or nose
  • Fever
  • Headache
  • Coughing
  • Shortness of breath
  • Bloody vomits
  • Altered mental status

What is Predisposes

  • Uncontrolled diabetes mellitus
  • Immunosuppression by steroids
  • Prolonged ICU stay
  • Co-morbidities – post transplant/malignancy
  • Voriconazole therapy

DOs & DON’s

  • 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
  • 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

How to prevent

  • 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

When to suspect (in COVID-19 patients, diabetics or immunosuppressed individuals)

  • Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone One sided facial pain, numbness or swelling
  • Blackish discoloration over bridge of nose/palate
  • Toothache, loosening of teeth, jaw involvement
  • Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
  • Chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms

How to manage

  • Control diabetes and diabetic ketoacidosis
  • Reduce steroids (if patient is still on) with aim to discontinue rapidly
  • Discontinue immunomodulating drugs
  • No antifungal prophylaxis needed
  • Extensive Surgical Debridement – to remove all necrotic materials
  • Medical treatment
    • Install peripherally inserted central catheter (PICC line)
    • Maintain adequate systemic hydration
    • Infuse normal saline IV before Amphotericin B infusion
    • Anti-fungal therapy, for at least 4-6 weeks (follow guidelines)
  • Monitor patients clinically and with radio-imaging for response and to detect disease progression

Team approach

  • Microbiologist
  • Internal Medicine Specialist
  • Intensivist Neurologist
  • ENT Specialist
  • Ophthalmologist
  • Dentist Surgeon (maxillofacial/plastic)
  • Biochemist
credit: Republic World (YouTube)

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