'Use steroids judiciously': Telangana govt issues guidelines to prevent mucormycosis

Mucormycosis is a rare black fungal infection which is now found in patients who have recovered from COVID-19 and could be life-threatening for patients with a weak immune system.
A team of doctors taking care of patients in a COVID-19 ward
A team of doctors taking care of patients in a COVID-19 ward
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With cases of mucormycosis, a rare black fungal infection among COVID-19 patients increasing across the country, the Telangana Director of Public Health (DPH) on Saturday issued guidelines for hospitals to prevent it. Mucormycosis could be life-threatening for patients with a weak immune system, such as people with severe diabetes.

The four guidelines released by the DPH include: 

> Better control of sugar levels during COVID-19 with or without steroids.

> Use steroids judiciously by observing correct timing, correct dose and correct duration. 

> Use antibiotics / antifungals judiciously.  

> Use clean, sterile water for humidifiers during oxygen therapy. 

Stating that mucormycosis is often reported due to poor maintenance of humidifiers, the DPH asked the medical superintendents of all private hospitals to always use distilled or sterile water in humidifiers.

The other standard operating procedure (SOP) includes:

> Never use unboiled tap water nor mineral water. Fill up to about 10 mm below the maximum fill line. Do not let the water level pass below the minimum fill line.

>  The water level should checked twice daily and topped up as necessary.

> The water in the humidifier should be changed daily.

> Humidifiers should be washed in mild soapy water, rinsed with clean water and dried in the air before reuse.

> Once a week (for the same patient) and in between patients, all the components of the humidifier should be soaked in a mild antiseptic solution for 30 minutes, rinsed with clean water and dried in the air. 

Mucormycosis is an infection caused by mucormycete molds, an organism present in the air, in leaves, piles of compost, soil and rotting wood. When exposed, the fungus can infect your central nervous system, eyes, sinuses, lungs, etc. But not everyone exposed to the fungus catches the infection. 

Early symptoms of the infection include obstruction in the nose, swelling in the eye or cheeks, and black dry crusts in the nose, smelly black nasal discharge, face numbness, fever, cold, etc. If neglected, it can even spread to the eyes and then the brain, making it fatal. If it enters the body via a cut or bruise in the skin, it could show up as blackened skin tissue. 

While presently, there are no studies linking COVID-19 to mucormycosis, many doctors have observed that recent mucormycosis cases coming for treatment are those who recently recovered from COVID-19 and who have high blood sugar levels. The number of such cases has also sharply risen, they say. However, mucormycosis is not contagious.

According to experts, typically, the infection overtakes the host when the latter is immunocompromised. That is why it is reported in persons with uncontrolled diabetes mellitus, HIV and cancer patients, those who had organ transplant, etc. Prior to COVID-19, most mucormycosis cases were reported in those with these conditions. 

However, since the pandemic, persons who have recovered from COVID-19 too, have been contracting the disease. In fact, the Gujarat Health Department had in December issued an advisory to doctors and officials over the recent spurt in cases among COVID-19 patients. Many of these cases are mucormycosis of the maxilla or upper jaw, which leads to the entire jaw detaching from the skull.

The United States’ Centers for Disease Control and Prevention (CDC) estimated a yearly rate of 1.7 mucormycosis cases per 1 million population. The CDC also reported a mortality rate of 54% for mucormycosis cases. 



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