Uncontrolled Diabetes, Improper Steroid Use Main Factors In Black Fungus: Study.
In the first evidence-based multicenter study of mucormycosis (black fungus) in India, doctors at PGIMER in Chandigarh said on Saturday that uncontrolled diabetes and improper use of steroids were the main contributors to its development.
However, they said the study failed to examine the role of the Covid-19 virus in causing immunity disorders that lead to mucormycosis.
More than 20,000 cases have been reported across India, said Arunaloke Chakrabarti, professor and head of the medical microbiology department at PGIMER.
16 health centers took part in the MucoCovi network study to provide detailed information on proven mucormycosis cases with and without Covid-19 infection from September 1 to December 31, 2020.
The prevalence of Covid-associated mucormycosis (CAM) was 0.27 percent in patients treated in hospital wards and 1.6 percent in patients treated in intensive care units.
In 2020, there was a 2.1-fold increase in mucormycosis cases in India compared to 2019, and research suggests that this increase was due to the pandemic.
The mortality rate from mucormycosis is much higher than that from Covid-19 infection. Early diagnosis and prompt treatment can save the patient.
The appearance of mucormycosis during the second wave is not new. During the first wave last year, doctors from leading institutes in the country noted an increase in the number of mucormycosis cases. They were curious to find out why mucormycosis developed.
Under the direction of doctors from the Postgraduate Institute of Medical Education and Research (PGIMER), a study called MucoCovi (Muco from Mucormycosis and Covi from Covid) was carried out at 16 centers.
The study results were published on Friday in the Emerging Infectious Disease Journal.
Chakrabarti said it was found that an average of 18 days after the Covid-19 infection was diagnosed with CAM. The most common sources of infection were the nose with eye involvement (58 percent of the cases), followed by the nose with eyes and brain involvement (27 percent) and then the lung infection (nine percent of the cases).
It shows a significant number of patients being hospitalized late after the disease spread to the brain. Also, facial pain, nasal congestion, and discharge; Toothache and tooth loosening were observed for the first time in a large number of cases.
A comparison of the cases of CAM with mucormycosis without Covid-19 (i.e. without CAM) showed that uncontrolled diabetes mellitus was the most common underlying disease in both groups.
Newly discovered diabetes mellitus was more common in patients with CAM than in non-CAM cases (20.9 percent versus 10 percent). This suggests the direct role of Covid-19 in causing or worsening diabetes, which can predispose these patients to mucormycosis.
In fact, patients with diabetic ketoacidosis developed CAM early, that is, in less than eight days from Covid-19. On the other hand, the patients who later developed a CAM had mostly received steroid treatment.
It was found that the inappropriate use of steroids (63.3 percent), i.e. either in very high doses or in patients who did not need them, with the development of late CAM, i.e. more than eight days after the Covid-19- Diagnosis, was connected.
The overall mortality rate from mucormycosis (both CAM and non-CAM) was 38.3 percent after six weeks and 45.7 percent after 12 weeks of illness, according to the study.
It showed that patients under the age of 54, those with brain or lung involvement, and those who had to undergo an intensive care unit, had a higher risk of death.
The authors conclude that the Covid-19 pandemic has led to an increase in mucormycosis cases from India. Mucormycosis is a critical problem that complicates the later part of the clinical course of Covid-19 in India due to improper use of glucocorticoids.
Given the gaps in the study, doctors have planned another large-scale multicenter study at 30 centers across the country. They say the study results are likely within the next three months.
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