Govt issues guidelines for mucormycosis in COVID-19 patients

The Centre on Sunday released dos and don’ts for screening, diagnosis and management of mucormycosis, or ‘black fungus’ infection, among survivors of COVID-19.

Mucormycosis is a serious but rare fungal infection. It mainly affects people who have health problems or take medicines that compromise the body’s ability to fight germs and sickness.

Also read: Cases of mucormycosis rise among COVID patients in Ahmedabad

The guidelines were prepared by the health ministry and Indian Council of Medical Research:

Warning Signs and Symptoms

Pain and redness around eyes and/or nose; fever; headache; coughing; shortness of breath; blood in vomit; altered mental status

Predisposition

Uncontrolled diabetes mellitus; immunosuppression by steroids; prolonged ICU stay; co-morbidities – post transplant/malignancy, voriconazole therapy

Dos

Control hyperglycaemia; monitor blood glucose level post COVID-19 discharge 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

Don’t

Miss warning signs and symptoms; consider all cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators; hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology; lose crucial time to initiate treatment

Preventive Measures

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 (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 discolouration over bridge of nose/palate; toothache, loosening of teeth, jaw involvement; blurred or double vision with pain; fever, skin lesion; thrombosis and necrosis (eschar); chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms

Management of Mucormycosis

Control diabetes and diabetic ketoacidosis; reduce steroids (if patient is still on) with aim to discontinue rapidly; discontinue immunomodulating drugs; no antifungal prophylaxis needed; extensive Surgical Debridement – to remove all necrotic materials

Medical Treatment

Install peripherally inserted central catheter (PICC line); maintain adequate systemic hydration; infuse normal saline IV before Amphotericin B infusion; antifungal therapy, for at least four to six weeks; monitor patients clinically and with radio-imaging for response and to detect disease progression

The government also shared a link (https://www.ijmr.org.in/temp/IndianJMedRes1392195 -397834_110303.pdf) for detailed management guideline followed globally. It is an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium.