The Centre asked the States and Union Territories to declare of Mucormycosis or black Fungus https://indianf.com/black-fungus-on-a-rise-in-covid-19-patients/ an epidemic under the Epidemic Disease Act, 1897. The Centre gave the direction in the wake of increasing cases of Black Fungus across the country.
In a letter to the States and Union territories, Joint Secretary in the Union Health Ministry Lav Agarwal said that all government and private health facilities along with medical colleges should follow guidelines issued by the ministry in ICMR on screening, diagnosis, and management of mucormycosis. The letter read that several states had reported Black Fungal in recent times and called for taking all precautions.
MORBIDITY
In the letter, the ministry said that the fungal infection led to prolonged morbidity and mortality among COVID 19 patients. The Centre also stated that it should be mandatory for all the health care centres, medical colleges and hospitals to report all suspected and confirmed cases of the disease to the health department in the states. These should then be reported to the Integrated Disease Surveillance Programme of the Health Ministry.
Telangana and Rajasthan have already declared Black Fungus as epidemic. Kerala, Uttarakhand, Karnataka, Telangana, Andhra Pradesh, Madhya Pradesh, Bihar and Haryana have already reported such cases.
Mucormycosi, is a rare but serious fungal infection caused by a kind of fungus called mucormycete, mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.
In an advisory, the Indian Council of Medical Research and the Government of India said that the fungal attack might turn fatal if not treated.
Warning Signs and Symptoms
- Pain and redness around eyes and/or nose
- Fever
- Headache
- Coughing
- Shortness of breath
- Bloody vomits
- Altered mental status
- Toothache, loosening of teeth
- Blurred or double vision with pain
What predisposes
- Uncontrolled diabetes mellitus
- Immunosuppression by steroids
- Prolonged ICU stay
- Co-morbidities – post transplant/malignancy
- Voriconazole therapy
Prevention
Use masks if you are visiting dusty construction sites.
Wear shoes, long trousers, long-sleeved shirts and gloves while gardening.
Maintain personal hygiene including a thorough scrub bath.
Diagnosis
It depends on the location of the suspected infection. A sample of fluid from the respiratory system may be collected for testing in the lab; otherwise a tissue biopsy or a CT scan of the lungs and sinuses may be conducted.
Treatment
Mucormycosis needs to be treated with prescription antifungal medicine. In some cases, it can require surgery. It can lead to eventual loss of the upper jaw and sometimes even an eye.
It is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs. To maintain adequate systemic hydration, the treatment includes infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks.
Dos
- Control hyperglycemia
- Monitor blood glucose level post COVID-19 discharge and also in diabetics
- Use steroid judiciously – correct timing, correct dose and duration
- Always use clean, sterile water for humidifiers during oxygen therapy
- Use antibiotics/antifungals judiciously
Don’ts
- Do not miss warning signs and symptoms
- Never 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
- Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology
- Do not lose crucial time to initiate treatment for mucormycosis
