Hyderabad: Complications that were unheard of in the first wave are surfacing during the second wave. The spread and severity of infection have increased manifold. Hence, changes to diagnosis and treatment protocols have become inevitable too. Immunosuppressant drugs, or steroids, are being administered to patients with severe symptoms, to prevent cytokine storm.
However, misuse or overdose of these drugs in COVID-19 treatment are making patients vulnerable to a slew of other infections besides giving rise to complications in chronic diabetics. At present, Mucormycosis, a fungal infection, is appearing in people suffering from COVID-19 in Telangana and Andhra Pradesh. The fungus first affects the nasal cavity, and gradually creeps into sinuses, eyes and then to the brain membrane. The infected area can look like blisters, and eventually turns black.
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Mucormycosis or black fungus is on the rise among COVID-19 patients. Though it is not a contagious disease, if left untreated, the fungal infection can prove fatal. Chronic diabetics treated with immunosuppressant drugs during COVID-19 treatment are at higher risk for black fungus. Initial cases were reported in Gujarat and Maharashtra. But the infection has surfaced in Telugu states too. ENT doctors have reported that patients with Mucormycosis symptoms are getting admitted in hospitals. The infection is fully curable with early diagnosis and treatment. But if the fungus reaches the brain membrane, which usually happens two to four days after the symptoms appear, there is hardly any chance of recovery.
Why is it affecting patients now?
Mucormycosis is an infection caused by Mucorales, an order of fungi. Since these fungi exist in the environment around us, the infection is nothing new. But it used to affect people with autoimmune disorders such as diabetes or those who have undergone organ transplants. In these cases, the doctors would administer immunosuppressant drugs, or steroids to suppress an overactive immune system. Thanks to the developments of medical science, advanced steroids have reduced the risk of black fungus. At present, overuse of steroids in COVID-19 cases has led the fungal infection to resurface. Since the majority of first wave infections did not need steroid treatment, there were not many cases of black fungus. But black fungus is further complicating the battle with the pandemic.
Symptoms to watch out for!
- Black fungus attacks the ears, nose, and eyes. In rare cases, it may infect the lungs. The patient may feel pain in the eyes, jaws, and face.
- Nasal congestion, dryness, discomfort, itching sensation, and black discharge from nose.
- Facial pain, numbness, and swelling. Severe headache.
- Pain around the eyelid. Protruded eyelids. Blurred vision. Watery eyes. Double vision.
- Fever. Pain in the upper part of the jaw.
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Who is at risk?
Generally, patients who recently got discharged from hospitals after undergoing COVID-19 treatment are at a greater risk. Immunosuppressant drugs have become a part of the COVID-19 treatment protocol across the world now. Doctors usually prescribe appropriate doses as per the patient’s condition. People with mild or moderate symptoms should not take steroids without consulting the doctor. Self medication is proving fatal in patients undergoing home isolation.
Early diagnosis is the key!
Since the fungal spores are in the air, they may enter the body through nose. From there, the fungus reaches the sinuses. With early detection, Mucormycosis can be treated by injecting Amphotericin-B. The treatment takes 2 to 3 weeks. If the disease has progressed to other mucous membranes, the doctors may remove the infected tissue. In order to prevent the infection from spreading to the brain, the eyeball and upper teeth may also need to be removed in severe cases. The disease is 90 percent curable if diagnosed at an early stage.
Two or three in 100
Out of 100 ENT out-patients at our hospital, two or three have Mucormycosis symptoms. The infection appears to be exacerbated in chronic diabetics and people who have recently recovered from COVID-19. In case a patient was administered steroids during COVID-19 treatment, he must immediately consult an ENT specialist in case of the aforementioned symptoms. Purified and distilled water are used in the flow meter that supplies oxygen to those on ventilator or oxygen bed. Though the initial argument was that Mucormycosis is caused by contaminated water in the flow meter, there was no scientific evidence to prove so. Those who use oxygen concentrator at home or hospital should ensure purified water in the flow meter, said Dr Singari Prabhakar, ENT specialist, Vijayawada
Nasal douching
Diabetics and patients on immunosuppressant medication must follow strict personal hygiene. Nasal douching helps keep the nose clean and healthy. By sniffing a saline or betadine solution into the nostrils, any debris and fungal spores can be removed. Mucormycosis is caused due to thrombogenicity (blood clots), use of steroids, and increased ferritin levels in COVID-19 patients. 9 people underwent surgery at our hospital in the past week. Even if the nose cartilage is obstructed or bent, the fungus gets accumulated there. If left untreated, the fungus affects the eyes and jaws. The blood supply to these tissues is cut off, giving a blackish appearance on the outside. If the infection reaches the brain, the fatality is almost 80 percent. In severe cases where patients have recovered, paralysis is not uncommon. In people with compromised immune system, the fungus reaches the brain membrane within two to four days. In others, it may take 8 to 9 days, said Dr R Vidyasagar, ENT surgeon, Vijayawada
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Steroids should not be used as soon the patient tests positive for COVID-19. If the fever does not come down after five days, or if the oxygen saturation drops below 95; the doctor will take a call on the course of action. Steroids weaken the immune response. The functioning of neutrophils (a type of white blood cells) gets impacted. At the same time, steroids raise the blood glucose levels in the body. In a few patients, a rise in serum ferritin levels was notice too. All the factors act as catalysts for fungal growth, making the patient vulnerable to Mucormycosis.
Black fungus cases in Telangana
Three cases of Mucormycosis were reported at Gandhi Hospital, Hyderabad. Several patients are undergoing treatment for black fungus in private hospitals. A person from Bhainsa (Nirmal district) was reported to have died of black fungus while undergoing treatment at a private hospital. The hospital authorities have not confirmed it yet. Recently, three people who got discharged from private hospitals after undergoing COVID-19 treatment joined Gandhi Hospital. Doctors identified black fungus infection and began the treatment immediately. Of them, two are stable while the condition of the third was reported to be critical.
Do not panic!
Black fungus is a relatively older disease unlike COVID-19. In fact, we have identified the fungal infection in 10 patients who got treated at Gandhi Hospital during the first wave. Of them, 8 have recovered without any medical intervention. Not every COVID-19 patient contracts black fungus. Recently, we have identified black fungus in 3 patients at our hospital. All of them are chronic diabetics, and had severe COVID-19 symptoms. It is not true that every patient who had been on a course of immunosuppressant medication gets black fungus. Post recovery, patients must stick to nutritious diet and ensure 8 hours of sleep to boost their immunity. Anxiety and fear are detrimental to immunity, said Dr Raja Rao, Superintendent, Gandhi Hospital
