With cases of mucormycosis or black fungus infection, on the rise in states like Maharashtra and Delhi, the Union Health Ministry has issued a list of dos and don’ts for recovered Covid patients who could be experiencing the symptoms.
In a separate press statement, the Union health ministry answered some common questions about the infection.
What is mucormycosis?
Mucormycosis or black fungus is a complication caused by a fungal infection. People catch mucormycosis by coming in contact with the fungal spores in the environment. It can also develop on the skin after the fungus enters the skin through a cut, scrape, burn, or another type of skin trauma.
The disease is being detected among patients who are recovering or have recovered from Covid-19. Moreover, anyone who is diabetic and whose immune system is not functioning well needs to be on the guard against this.
The following conditions in Covid-19 patients increase the risk of mucormycosis infection:
- Uncontrolled diabetes
- Weakening of immune system due to use of steroids
- Prolonged ICU/hospital stay
- Co-morbidities/post organ transplant/cancer
- Voriconazole therapy (used to treat serious fungal infections)
How is the infection related to Covid-19?
The disease is caused by a set of micro-organisms known as mucormycosis, which are present naturally in the environment, seen mostly in soil and in decaying organic matter like leaves, compost and piles.
In the normal course, our body’s immune system successfully fights such fungal infections. However, Covid-19 affects our immune system. Moreover, the treatment of Covid-19 patients involves the intake of drugs like dexamethasone, which suppresses our immune system response. Due to these factors, Covid-19 patients face a renewed risk of failing the battle against attacks mounted by organisms such as mucormycosis.
In addition, Covid patients undergoing oxygen therapy in ICU, where a humidifier is used, are prone to fungal infection because of exposure to moisture.
But this does not mean that every Covid patient will get infected by Mucormycosis. The disease is uncommon in those not having diabetes but can be fatal if not treated promptly. Chances of recovery depend upon early diagnosis and treatment.
What are the common symptoms?
Mucormycosis begins to manifest as skin infection in the air pockets located behind our 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 Indian Council of Medical Research has advised that not all cases of blocked nose should be considered as cases of bacterial sinusitis, particularly during/after the treatment of Covid-19 patients. One must seek medical help for detecting fungal infection.
How is it treated?
While the infection may just begin with a skin infection, it can spread to other parts of the body.
Treatment involves surgically removing all dead and infected tissue. In some patients, this may result in loss of the upper jaw or sometimes even the eye.
The cure may also involve a 4-6 weeks course of intravenous anti-fungal therapy. Since it affects various parts of the body, treatment requires a team of microbiologists, internal medicine specialists, intensivist neurologists, ENT specialists, ophthalmologists, dentists, surgeons, and others.
Controlling diabetes is one of the foremost prevention methods suggested by ICMR. Hence, Covid-19 patients who are diabetic need to take utmost care.
Self-medication and over-dosage of steroids can result in fatal events and hence doctor’s prescription should be strictly followed.
Speaking about the adverse effects of inappropriate use of steroids, Niti Aayog member Dr. V K Paul says: “Steroids should never be administered at an early stage of Covid-19. They should be taken only after the sixth day of infection. Patients should stick to appropriate doses of the drugs and take the drug for a specific number of days as advised by the doctors. Rational use of medicines should be ensured to avoid adverse side effects of the drug.”
“Other than steroids, use of Covid-19 drugs such as Tocilizumob, Itolizumab also suppresses the immune system. And when these drugs are not used appropriately, it increases the risk, as our immune system fails to fight the fungal infection.” Dr. Paul adds.
For patients on oxygen therapy, it should be ensured that the water in the humidifier is clean and is refilled regularly. Attention should be paid to ensure there is no leakage of water (to avoid wet surfaces where the fungus can breed). Patients should maintain proper hygiene by keeping their hands as well as a body clean.