Black Fungus Infection: Govt Releases Dos & Don'ts For COVID-19 Survivors

The Central government on Sunday released an advisory for screening, diagnosis and management of mucormycosis or ‘black fungus’ infection that is being widely reported among COVID-19 survivors in the country. According to the Union Health Ministry, mucormycosis is a fungal infection that mainly affects people who are on medication and reduces their ability to fight environmental pathogens. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from air and it may turn fatal if not cared for.

The Health Ministry and ICMR that have been in the frontline of the government’s battle against the pandemic have prepared guidelines to prevent or manage the disease.

Sign and symptoms of mucormycosis/black fungus

• Pain and redness around eyes and/or nose
• Fever
• Headache
• Coughing
• Shortness of breath
• Bloody vomits
• Altered mental status

What are the predispositions

• Uncontrolled diabetes mellitus
• Immunosuppression by steroids
• Prolonged ICU stays
• Co-morbidities – post-transplant/malignancy
• Voriconazole therapy

What should you do?

• Control hyperglycemia
• Monitor blood glucose level after COVID-19 recovery and also in diabetics
• Use steroid judiciously – correct timing, correct dose and duration
• Use clean, sterile water for humidifiers during oxygen therapy
• Use antibiotics/antifungals judiciously

What should you not do?

• Do not miss warning signs and symptoms
• Do not consider all the cases with a 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 aetiology
• Do not lose crucial time to initiate treatment for mucormycosis

How to prevent mucormycosis/black fungus?

• Use masks if you are visiting dusty construction sites
• Wear shoes, long trousers, long sleeve shirts and gloves while handling soil (gardening), moss or manure
• Maintain personal hygiene, including thorough scrub bath

When to suspect the fatal infection?

(in COVID-19 patients, diabetics or immunosuppressed individuals)

• Sinusitis – nasal blockage or congestion, nasal discharge (blackish/bloody), local pain on the cheekbone or one-sided facial pain, numbness or swelling
• Blackish discolouration over the 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 mucormycosis?

1. Control diabetes and diabetic ketoacidosis
2. Reduce steroids (if the patient is still on) with the aim to discontinue rapidly
3. Discontinue immunomodulating drugs
4. No antifungal prophylaxis needed
5. Extensive Surgical Debridement - to remove all necrotic materials
6. What is the medical treatment for mucormycosis?
7. Install peripherally inserted central catheter (PICC line)
8. Maintain adequate systemic hydration
9. Infuse normal saline IV before Amphotericin B infusion
10. Antifungal therapy, for at least 4-6 weeks (follow guidelines)
11. Monitor patients clinically and with radio-imaging for response and to detect disease progression

Whom should you consult?

• Microbiologist
• Internal Medicine Specialist
• Intensivist Neurologist
• ENT Specialist
• Ophthalmologist
• Dentist Surgeon (maxillofacial/plastic)
• Biochemist                                                                            
  

  This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     
  

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Covid-induced ‘black fungus’ cases on the rise in some hospitals

Doctors at a private facility in Delhi are seeing a rise in the number of Covid-triggered mucormycisis cases, according to a statement from the hospital.

Mucormycisis is a fungal infection triggered by Covid-19. Black fungus or mucormycosis has been a cause of disease and death of patients in transplants, ICUs and immunodeficient patients since long.

According to Dr Manish Munjal, senior ENT surgeon at the Sir Ganga Ram Hospital, "We are seeing a rise again in this dangerous fungal infection triggered by Covid-19. In the last two days, we have admitted six cases of mucormycisis. Last year, this deadly infection caused high mortality with many patients suffering from the loss of eyesight and the removal of the nose and the jaw bone."

Dr Ajay Swaroop, the chairman of the ENT department at the hospital, said the use of steroids in the treatment of Covid-19 coupled with the fact that many coronavirus patients have diabetes could be one of the reasons for this rise in the number of black fungus cases again.

He said the infection is commonly seen in patients who have recovered from Covid-19 but have comorbidities such as diabetes, kidney or heart failure or cancer.

Munjal concurred with his colleague and said Covid patients with a weak immunity are more prone to this deadly infection.

"Early clinical suspicion on symptoms such as nose obstruction, swelling in the eyes or cheeks and black crusts in the nose should immediately prompt a biopsy and start of anti-fungal therapy as early as possible," he said.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

https://gscrochetdesigns.blogspot.com. one can see my crochet creations  
https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes    
https://kneereplacement-stickclub.blogspot.com. for info on knee replacement