Dr Arunaloke Chakrabarti, head of the department of microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh on Friday said that the city’s premier medical institute is recording a spike in cases of mucormycosis, a potentially deadly fungal infection, as the surge in COVID-19 cases has led many people to be prescribed steroids and immunomodulators, which leave some people vulnerable to other pathogens.
Dr Chakraborty, who is a part of the Fungal Infection Study Forum and is one of the members who drafted the government advisory on mucormycosis, said that many Covid-19 patients either have underlying diabetes or their blood sugar levels became uncontrollable because of the excess steroids given for treatment. People should know symptoms of the fungal infection to avoid serious complications. Mucormycosis has been seen among those who have uncontrolled diabetes, whose immunity is compromised or those who are given excessive steroids. It is necessary for post-covid patients to get diabetes under control to reduce chances of infection, he added.
He said that the sudden increase has also resulted in a shortage of anti-fungal medicines used for treating the infection in many cities of the country. So far, there is no shortage of anti-fungal medicines at PGIMER.
In an interview with ‘The Pioneer’, Dr Chakraborty talks about the current status of mucormycosis cases in Chandigarh and neighbouring States, as well as an arrangement, made at PGIMER for such patients: Excerpts from the interview:
What are the actual reasons for increasing mucormycosis cases in Chandigarh and neighbouring States Punjab, Haryana and Himachal Pradesh?
There has been a spike in cases of mucormycosis in the region. Many Covid-19 patients either have underlying diabetes or their blood sugar levels become uncontrollable because of the excessive steroids given for treatment. There are three known reasons for it. One, uncontrolled sugar in Covid-19 patients; Covid-19 patients who have diabetes may be at risk of contracting the infection (mucormycosis). Two, for those without diabetes, high use of steroids may lead to poor glycemic control after Covid-19, thereby leading to the fungal infection. Three, the ferritin levels go up during a Covid-19 infection. Ferritin is known to contain iron which is a good food for mucormycosis.
How to identify signs and symptoms of mucormycosis?
People should know symptoms of the fungal infection to avoid serious complications. The study found the infection usually happens 18 days after the onset of Covid-19. So people should look out for pain in the left or right side of the face, nasal blockage, nasal discharge, especially black discharge. Loosening of teeth has also been seen this time. If a diagnosis is delayed and the infection enters the eye orbit, it causes double vision, blurring, or protrusion of the eye. It can also cause ulcers in the palate of the mouth. Paresthesia (altered sensation), swelling of eyes, numbness in cheeks, dryness of nose and severe headache, which do not come down with medication and nasal discharge with blood traces are some of the symptoms of Mucormycosis. The headache will give one sleepless nights.
When should patients consult a doctor?
Patients having above symptoms should consult the doctor immediately. The toughest challenge with Mucormycosis is the need for treatment at least within two days. If left untreated, it may kill those infected. If not detected early, it affects the orbit of the eye and the mouth, resulting in people losing their vision or jaw during debridement — the process of removing dead tissue from an infection or wound. Checking blood sugar levels regularly and keeping it under control is extremely important. It is easy to put a check on Fungus if people monitor their blood sugar levels and do not neglect warning symptoms.
How many patients with mucormycosis are admitted at PGIMER?
About 3-5 post-covid patients with mucormycosis are being admitted at PGIMER on a daily basis over the last one month. Before Covid-19, very few fungal infection cases were being reported. For the first time, such patients were admitted at PGIMER in September last year. In the second wave of the pandemic, many more post-covid patients are being admitted at the institute with mucormycosis as compared to the first wave of the pandemic. We are seeing a surge of such cases since April this year.
Which Covid-19 patients are having more threat of being infected to mucormycosis?
Mucormycosis has been seen among those who have uncontrolled diabetes, whose immunity is compromised or those who are given excessive steroids or immune-modulating drugs such as tocilizumab.
Has any doctor from Punjab, Haryana, Himachal Pradesh consulted PGIMER for treatment of such patients?
Many doctors of neighbouring states have approached us for antifungal drugs as it is not freely available and there is a shortage because the demand has gone up again.
What precautions should covid-19 patients take to avoid mucormycosis?
People should maintain sugar level and basic hygiene after recovering from Covid-19 to ensure that they do not get any infections, and also get their blood sugar levels tested.
Does PGIMER have sufficient specific anti-fungal medicine used in treatment of Mucormycosis, which is increasingly being detected among post-covid patients?
So far, antifungal medicine used in the treatment of mucormycosis is available. But we may face a shortage of such medicines in near future as such cases are on the rise.
