By Pauline Achieng’ Tom | @pauline_tom
There is an increased risk of succumbing to mucormycosis in recovered severe COVID-19 patients, with mortality rates at between 50 and 70 per cent, experts warn.
The sudden rise of mucormycosis, also known as black fungus, has been attributed to COVID-19, usually presenting in patients third to fourth week after recovery from COVID infection but occasionally it can develop during ongoing COVID-19 infection itself.
According to the medical journal of virology, COVID-19 patients with comorbidities such as uncontrolled diabetes, those on steroids, renal transplant patients, patients on immunosuppressive treatment for blood cancer (Leukemia), patients on chemotherapy and radiotherapy are at a higher risk of contracting mucormycosis.
The use of glucocorticoids is also a known risk factor that might predispose patients to development mucormycosis due to glucocorticoid-induced immunosuppression. 85 per cent of patients on glucocorticoid treatment developed mucormycosis.
Mucormycosis a once-rare disease caused by fungus that occurs naturally in the environment has now become deadly especially among patients with COVID-19. According to Dr. Shailendra Inamdar ENT specialist at M.P. Shah Hospital, the best care for mucormycosis is preventive care, while early diagnosis and treatment are important for those infected, management in patients who are predisposed is important.
“A high index of suspicion is necessary in all COVID-19 patients but more so for those in a high-risk group, patients with diabetes mellitus, should have a proper control of blood sugar all the time,” he said.
Dr Inamdar stressed the importance of the management of corticosteroids, advising that steroids in the management of COVID patients should be used in mild to moderate dosage only and beyond the 10th day of infection under medical supervision.
“They should not be self-prescribed or should not be given by pharmacists. Also, optimal duration for its use is 10 days. COVID patient’s rooms and wards should be regularly disinfected to reduce the presence of Mucor spores in the environment.
“Also, while administering humidified oxygen, only sterile water should be used,” he added.
Early diagnosis is essential in saving patients’ lives, especially since the disease carries high mortality of 50 per cent to 70 per cent, the signs and symptoms from mucormycosis include blackish discolouration of the nose, turbinate, palate, swelling around the eyes, reduced sensation (paraesthesia) over cheeks, reduced vision in one eye, nose bleed, nasal discharge involving one side, headache (Rhino cerebral mucormycosis), chest pain, fever, breathlessness (pulmonary mucormycosis).
Mucormycosis diagnosis is done through CT/MRI or microscopic examination of fungus and biopsied tissue that will show aseptate hyphae, this is done to distinguish mucormycosis from other healthcare-associated (HAIs) fungal infections which patients hospitalized with severe covid-19 are highly disposed to like candidemia, doctors should consider the possibility of mucormycosis in patients with severe COVID-19 who have worsening respiratory function or sepsis.
According to the medical virology journal, the treatment for mucormycosis mainly involves injectable antifungals such as Liposomal Amphotericin B usually administered in 21 days sometimes though aggressive surgical intervention is required.
“Patients with necrosis of tissues in nose, sinuses or eye require surgical debridement of the affected tissues by ENT surgeon if the eyeball is involved it is removed by Eye Surgeon which may lead to blindness. If the fungus requires brain / cavernous sinus, it is usually fatal,” said Dr Inamdar. Given the high fatality of the disease extreme alertness is encouraged since mucormycosis sometimes presents as other fungal infections such as aspergillosis or invasive candidiasis.
“Mucormycosis is a deadly/ dangerous fungal infection seen in patients recovering from COVID-19. It is preventable and can be prevented by taking care of blood glucose levels in Diabetic Patients, minimizing the use of steroids, proper hygienic use of humidified oxygen if required and keeping a high index of suspicion,” Dr Inamdar told Health Business.
