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