Covid-diabetes hyperlink resulting in black fungus, really feel specialists : The Tribune India

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Naina Mishra

Tribune news service

Chandigarh, June 13th

370 cases of mucormycosis have been observed in city hospitals to date, with the majority of these patients being uncontrolled diabetics and receiving steroids in inappropriate amounts during Covid treatment.

“At least 87 percent of the mucormycosis patients enrolled in the PGI are diabetics. This is the main contributing factor to this fungal infection. At the same time, there are quite a good number of patients who came with mucormycosis but were Covid-positive in the RT-PCR test. They were asymptomatic for Covid-19, “said Dr. Naresh Panda, Head of ENT Department, PGI.

There is now increasing evidence that Covid-19 triggers hyperglycemia even in patients. Dr. PGI’s DG Puri said symptomatic patients, even with no history of diabetes, had shown diabetes failure at PGI, Chandigarh.

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Covid-19 directly affects the beta cells in the pancreas, causing the patient’s sugar levels to skyrocket. The coronavirus directly damages beta cells, which leads to hyperglycemia. In addition, the cytokine storm caused by Covid-19 and the steroids used for treatment also contribute to the increased sugar levels. —Dr. Sanjay Badada, Department of Endocrinology, PGI

Dr. Sanjay Badada, from the Department of Endocrinology, PGI, said, “Covid-19 affects the beta cells in the pancreas directly, causing the patient’s sugar levels to skyrocket. The coronavirus directly damages beta cells, which leads to hyperglycemia. In addition, the cytokine storm caused by Covid-19 and the steroids used for treatment also contribute to increased sugar levels.

He said that uncontrolled diabetes causes acidosis (too much acid in body fluids) and fungi like to grow in this environment.

The latest study of mucormycosis, led by PGI doctors and published in the CDC, USA, showed that inappropriate use of glucocorticoids has been linked to late Covid-associated mucormycosis. Appropriate steroid use was defined as dexamethasone equivalent doses of 6 mg / day for more than 10 days. Any exceedance of the dose or duration was classified as “inappropriate”.

Dr. Panda said several patients had been given excessive amounts of steroids from the outside. Their prescription cards were filled with high-dose steroids, which also caused an uncontrolled diabetic condition in these patients.

“None of the patients discharged from the PGI came with mucormycosis because they were all well treated for steroids and sugar levels. All of these patients were taking steroids either in isolation at home or in other private settings, ”he said.

However, some doctors feel that the role of steam inhalations, unsanitary face masks and oxygen humidifiers cannot be undermined in the increasing number of mucormycosis cases in the second wave.

Dr. Jagdish Chander, Consultant Microbiologist at GMCH-32, said, “Overzealous use of steam inhalation six to seven times a day and reusing the same mask for one to two weeks also increased the risk of developing mucormycosis. High clinical suspicion of mucormycosis should be maintained in patients who have recovered from the viral infection. “

Dr. Badada also highlighted the possible putative causes of mucormycosis in his recently published research. Reusable oxygen humidifiers could also play an important role in the transmission of potential nosocomial pathogens via the formation of aerosol particles, according to the paper, as they get deep into the lungs immediately after inhalation. The use of steam inhalation, as well as non-humidified oxygen, can damage the airway mucosa, which allows easy penetration of mucous membranes. Therefore, it should be limited to people after Covid, it said.

“Overzealous use of steam inhalation increased risk”

Dr. Jagdish Chander, Consultant Microbiologist at GMCH-32, said, “Overzealous use of steam inhalation six to seven times a day and reusing the same mask for one to two weeks also increased the risk of developing mucormycosis. High clinical suspicion of mucormycosis should be maintained in patients who have recovered from the viral infection. “