The rise in cases of mucormycosis or ‘black fungus’ infection among COVID-19 survivors, Government released an evidence-based advisory for screening, diagnosis and management of the disease.
Government said mucormycosis is a fungal infection that mainly affects people who are medication that reduces their ability to fight environmental pathogens.
Sinuses or lungs of such individuals get affected after fungal spores are inhaled from air.
These guideline was prepared by the Union Health Ministry and ICMR that have been in the frontline of the government’s war against the coronavirus pandemic.
This can lead to serious disease with following warning sign and symptoms
- Pain and redness around eyes and/or nose
- Fever
- Headache
- Coughing
- Shortness of breath
- Bloody vomits
- Altered mental status
Predisposition
- Uncontrolled diabetes mellitus
- Immunosuppression by steroids
- Prolonged ICU stay
- Co-morbidities
- Post transplant/malignancy
- Voriconazole therapy
What to Do
- Control hyperglycemia
- Monitor blood glucose level after COVID-19 discharge and also in diabetics
- Use steroid judiciously in correct timing, correct dose and duration
- Also Use clean, sterile water for humidifiers during oxygen therapy
- Use antibiotics/antifungals judiciously
What NOT to Do
- Do not ignore 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
- Also Do not hesitate to take aggressive investigations, as appropriate for detecting fungal etiology
- Do not lose crucial time to initiate treatment for mucormycosis
Preventive Measures
- Use masks if you are visiting any dusty sites
- Wear shoes, long trousers, long sleeve shirts and gloves while handling soil.
- Maintain personal hygiene
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 Black Fungus or Mucormycosis?
- Control diabetes and diabetic ketoacidosis
- Reduce steroids with aim to discontinue rapidly
- Discontinue immunomodulating drugs
- No antifungal prophylaxis needed
- Extensive Surgical Debridement
- To remove all necrotic materials
Medical treatment Black Fungus or Mucormycosis
- Install peripherally inserted central catheter (PICC line)
- Maintain adequate systemic hydration
- Infuse normal saline IV before Amphotericin B infusion
- Antifungal therapy, for at least 4-6 weeks (follow guidelines)
- Monitor patients clinically and with radio-imaging for response and to detect disease progression.
WARNING : If the problem isn’t solved by lifestyle changes alone then don’t hesitate to consult a doctor as this article is for knowledge base.
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