Covid-linked mucormycosis: Maintain diabetes in management, keep away from steroids, say docs

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Since the outbreak of the Covid-19 pandemic, very high incidence of mucormycosis in Covid-19 patients has been reported across the country on multiple occasions, particularly those who have diabetes who have received steroids.

Covid Associated Mucormycosis (CAM) has been linked to high morbidity and mortality, exorbitant treatment costs, and a lack of antifungal drugs.

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Speaking to The Indian Express, Professor Arunaloke Chakrabarti, Head of the Department of Medical Microbiology, PGI and Competent Center for Advanced Research in Medical Mycology, shares the recommendations of the Fungal Infection Study Forum, which he chairs, to clarify any misunderstandings related to this on CAM and DR RAJESH GERA, Senior Consultant Internal Medicine at Paras Hospital, are considered.

What are the symptoms of Covid Associated Mucormycosis (CAM)?

Patients with COVID-19 (active / recovering / after discharge) with Rhino-Orbito-Cerebral Mucormycosis (ROCM) complain of nasal blockage or congestion, nasal discharge (bloody or brown / black), and localized pain. Patients may also complain of facial pain, numbness or swelling, headache, orbital pain, toothache, loosening of the maxillary teeth, jaw involvement, blurred or double vision with pain. Other symptoms are paresthesia, fever, skin lesions, thrombosis and necrosis (scabs). Pulmonary mucormycosis can take the form of fever, cough, chest pain, pleural effusion, hemoptysis, and worsening respiratory problems.

Cutaneous mucormycosis shows skin involvement in blisters or ulcers in the affected areas. Other symptoms include pain, warmth, and swelling around the blisters.

A widespread Mucor develops in severely immunocompromised people, in whom the fungus spreads throughout the body and causes multiple organs to malfunction that can lead to shock and death.

Mucormycosis: What is the Treatment?

Mucormycosis is a medical emergency, even if clinically suspected. A team approach with infectious disease specialists, microbiologists, histopathologists, intensive care physicians, neurologists, ENT specialists, ophthalmologists, dentists, surgeons, radiologists, etc. is required. It is important to control diabetes and diabetic ketoacidosis. Reduce steroids (if the patient is still on them) with the aim of getting off quickly. Discontinue other immunomodulating drugs if the patient is taking them.

How can you prevent this infection?

Since poorly controlled diabetes is the main problem, good blood sugar control is required while treating COVID 19 patients. Systemic steroids should only be used in patients with hypoxemia. Oral steroids are contraindicated in patients with normal room oxygen saturation. If systemic steroid is used, blood sugar should be monitored. The dose and duration of steroid therapy should be limited to dexamethasone (0.1 mg / kg / day) for 5-10 days. The universal masking reduces exposure to mucorales. Avoiding construction sites is recommended. During patient discharge, advice on the early symptoms or signs of mucormycosis (facial pain, nasal congestion and over discharge, chest pain, respiratory failure).

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In addition to Covid patients, what other people should protect themselves from it?

Individuals with compromised immune systems, including organ transplant patients, patients with uncontrolled diabetes, HIV-positive patients, cancer patients, and those taking immunosuppressive drugs including steroids, should be careful. Black lesions on any part of the body are an indicator that they might be harboring this fungus.

What is the misinformation associated with CAM?

Mucorales are not black mushrooms. Black mushrooms are another category of mushrooms with melanin in the cell wall. Mucormycosis is not contagious. It doesn’t spread from one person to another. Mucormycosis is not spread through oxygenation, humidifiers, and water. The mushrooms remain indoors and outdoors. The spores enter the airways through the air. Antifungal prophylaxis is not recommended as the incidence in no Covid cohort is more than 10%. No slow escalation of amphotericin B during therapy. The full dose per day should be given on the 1st day. Voriconazole, fluconazole, and echinocandins are not effective against Mucorales.