Centre issues advisory on management of Mucormycosis fungal infection in Covid-19 patients

Mucormycosis, a fungal infection being found in Covid-19 patients with uncontrolled diabetes and prolonged intensive care unit (ICU) stay, may turn fatal if uncared for, the Centre said on Sunday.

In an advisory, it also said the fungal infection mainly affects people who are on medication that reduces their ability to fight environmental pathogens.

The evidence-based advisory for screening, diagnosis and management of the disease was released by the Indian Council of Medical Research (ICMR) and the Union health ministry.

Read more: Fungal infection cases rising in second phase of pandemic, warn Maharashtra, Gujarat doctors

"Mucormycosis, if uncared for, may turn fatal. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air," it said.

Warning symptoms include pain and redness around eyes and nose, fever, headache, coughing, shortness of breath, bloody vomits and altered mental status, the advisory stated.

In Covid-19 patients with diabetes and immuno-suppressed individuals, one must suspect of mucormycosis if there is sinusitis, one-side facial pain or numbness, blackish discoloration over the bridge of the nose or palate, toothache, blurred or double vision with pain, skin lesion, thrombosis, chest pain and worsening respiratory symptoms, it said.

Major risk factors for this disease include uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, malignancy and voriconazole therapy, the ICMR-health ministry advisory stated.

To prevent the disease, blood glucose level should be monitored post-Covid discharge and also in diabetic patients, steroids should be used judiciously in correct timing, dose and duration, clean sterile water should be used in humidifiers during oxygen therapy, and antibiotics and antifungal medicines should be used correctly, it said.

The disease can be managed by controlling diabetes, discontinuing immunomodulating drugs, reducing steroids and extensive surgical debridement- to remove all necrotic materials, according to the advisory.

Medical treatment includes installing peripherally inserted central catheter, maintaining adequate systemic hydration, infusion of normal saline intravenously before Amphotericin B infusion and anti-fungal therapy for at least six weeks besides monitoring the patient clinically with radio imaging for response and to detect disease progression, it said.