ICMR releases diagnosis and management guidelines for COVID-19-associated Mucormycosis

Several states in India see a rise in cases of black fungus – or ‘Mucormycosis’ – infection in people diagnosed with COVID-19. Such infections are emerging two weeks after a person has recovered from COVID-19. The Indian Council of Medical Research (ICMR) recently released guidelines for screening, diagnosing, and managing this infection. According to the ICMR, mucormycosis is a fungal infection that mainly affects people who are on medication for other health problems that hamper their ability to fight environmental pathogens.

In an interview with Firstpost, Dr. Mala V Kaneria, infectious diseases consultant at Jaslok Hospital and Research Centre, Mumbai, said, “Mucormycosis is an uncommon infection caused by mold from the family called Mucorales. This fungus is present everywhere and occurs mostly by inhalation where it enters the sinuses and lungs, or it can enter the body if a person has a burn, cut, or abrasion on the skin.”

She added that the correlation between COVID-19 and Mucormycosis isn’t surprising. The biggest risk factors for the black fungus infection are uncontrolled diabetes and steroids, which are known to suppress immunity and treat COVID-19 patients.

To eliminate this infection, it is important to diagnose the patient as aggressive and life-threatening quickly. It affects the sinuses, eyes and can even spread to the brain. If it affects the eyes, the patient may have to undergo evisceration (disembowelment of the eye) despite treatment. A patient is given a combination therapy of antifungal medication and cerebral or surgical debridement.

You could have Mucormycosis if you experience a blackish or bloody discharge from your nose, pain in your cheekbones, pain/numbness/swelling on your face; toothache, chest pain, and blurred vision are some of the the the other Mucormycosis symptoms.

What are the symptoms?

  • Pain and redness around eyes and/or nose
  • Fever
  • Headache
  • Coughing
  • Shortness of breath
  • Blood in vomit
  • Altered mental status

Who is most at risk?

  • Uncontrolled diabetes
  • Immunosuppression by steroids
  • Prolonged ICU stay
  • Comorbidities post-transplant/malignancy
  • Kidney disease
  • Cancer
  • Heart disease

How to prevent the infection

  • Use a mask if visiting a dusty construction site
  • Wear shoes, long trousers, long sleeve shirts, and gloves while handling soil.
  • Maintain personal hygiene

ICMR’s things-to-do

  • Control hyperglycemia
  • Monitor blood glucose level post- COVID-19 discharge
  • Use steroids judiciously – correct timing, dose, and duration
  • Use clean, sterile water for humidifiers during oxygen therapy
  • Use antibiotics/antifungals judiciously

ICMR’s things not-to-do

  • Do not miss warning signs and symptoms
  • Do not consider all cases with blocked nose to be bacterial sinusitis, especially in the context of immunosuppressors and/or COVID-19 patients on immunomodulators.
  • Do not hesitate to seek aggressive interventions.
  • Tests like KOH staining, microscopy, culture, MALDI-TOF can be done to detect fungal etiology.
  • Don’t lose crucial time by hesitating to initiate treatment.

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