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How to identify, treat black fungus affecting COVID infected patients

HealthHow to identify, treat black fungus affecting COVID infected patients

 

How to identify, treat black fungus affecting COVID infected patients
How to identify, treat black fungus affecting COVID infected patients

There is a new fatal complication that hits the brains, lungs, skin, jaws, etc., in COVID-infected patients having comorbidities such as diabetes, called black fungus or mucormycosis found frequently in patients in some states. Patients can also lose their eyesight or lives.  Serious cases require surgery.

With the rise in mucormycosis or black fungus cases in Karnataka among COVID-19 patients, the Karnataka government has asked the Centre to supply 25,000 doses of amphotericin B which is an antifungal medicine used to treat serious fatal cases of fungal infection and the only medicine to treat black fungus.

The Karnataka Health Minister Dr K Sudhakar said “During the video conference with Union Health Minister Dr Harsh Vardhan we put forth a demand for 25,000 (doses of) amphotericin B.” Sudhakar also said that due to the excess use of steroids and also patients with diabetes, cases of black fungus are being detected as post-COVID complications.

According to Trust Well Hospital, in the last two weeks, 38 people have been treated for black fungus infection in Bengaluru. A special unit has been set up at the hospital for the purpose of providing special care to the infected.

Dr Deepak Haldipur, head of the Department of Special Treatment of Mucormycosis at Trust Well Hospital, said that in COVID infected patients with diabetes, increased sugar levels with steroid use progresses fungal increase. Also, in some cases, steroid and high potency antibiotics are given. Some of these patients have reduced immunity due to its adverse effects. Then, that acts as fertile ground for the fungus or mucormycosis, causing many complications.

Based on the frequently asked questions about black fungus, Dr. K. Sudhakar Health Minister of Karnataka addressed these, look below:

What is Mucormycosis?

Mucormycosis is a fungal infection mainly affecting people with medical health problems that reduce their ability to fight environmental pathogens.

How can a patient contract the infection?

People having co-morbidities, voriconazole therapy, uncontrolled diabetes mellitus, immunosuppression by steroids or prolonged ICU stay can get predisposed to the fungal infection.

What are possible symptoms of Mucormycosis?

Pain or redness around the eyes, fever, headache, coughing, shortness of breath, bloody vomit and altered mental status are possible symptoms of the infection, the minister added

“Don’t consider all cases of blocked nose as cases of bacterial sinusitis, especially in the cases of immunosuppression and/ or COVID-19 patients on immunomodulators,” the minister advised in his tweet.

 

Symptoms of Black Fungus officially known as MucormycosisFacial Deformity

Excruciating headache
Facial pain
Nasal congestion
Loss of vision or pain in the eyes
Altered mental state, confusion
Swelling in cheeks and eyes
Toothache, loosening of teeth
Black crusts in the nose

Dos and Don’ts for black fungus in COVID patients

Do not avoid the signs and symptoms of black fungus infection. It can be very dangerous if it reaches the brain.
Control hyperglycemia
Monitor blood glucose level post-COVID-19 discharge and also in diabetics
Use steroid judiciously – correct timing, correct dose and duration
Use antibiotics/antifungals judiciously
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 lose crucial time to initiate treatment for mucormycosis
People with diabetes, those on steroids and humidified oxygen for a long time, and Covid patients with pre-existing comorbidities are the most at risk. Others include patients like those post chemotherapies, those on long-term immunosuppressive drugs.

One question:  Will those who have taken the COVID vaccine survive this black fungal infection?

“There is no relation between taking the vaccine and black fungal infection. If one has taken a vaccine shot, they are likely to have a mild COVID infection which won’t require steroids and hence they are unlikely to have the black fungus,” according to medical experts.

Treatment for Black Fungus:

 Amphotericin B is the best-treated drug for this.  If uncontrolled, one may require surgery.

Doctors have said that it is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs.

To maintain adequate systemic hydration, the treatment includes an infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks.

Experts in the task force have stressed the need to control hyperglycemia, and monitor blood glucose level after discharge following COVID-19 treatment, and also in diabetics.

One should use steroids carefully,— correct timing, correct dose and duration are important.

Treating COVID-infected patients with mucormycosis needs a team effort involving microbiologists, dentists, internal medicine specialists, intensivist neurologists, ENT specialists, ophthalmologists, surgeons (maxillofacial/plastic) and others because it is a complex disease.

 

Maharashtra Health Minister Rajesh Tope has said there could be over 2,000 such cases in the state as of now, and with more and more COVID-19 cases coming up “their number would increase for sure”.

As many as 111 patients, all COVID-19 survivors, are undergoing treatment for mucormycosis in hospitals in the state capital Mumbai, according to the Brihanmumbai Municipal Corporation (BMC). A 44-year-old man in Mumbai lost his eyesight due to this black fungal infection.

 

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