ICMR Advisory on ‘Black Fungus’ among COVID Patients; Check Do’s and Don’ts

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TNI Bureau:  As reports emerge of the rise in cases of black fungus infections or ‘mucormycosis’ in survivors of Covid-19, the Indian Council of Medical Research (ICMR), New Delhi has released an advisory for screening, diagnosis and management of the disease.

The fungal infection detected in COVID-19 patients with uncontrolled diabetes and prolonged ICU stay and is likely turn fatal if uncared.

It usually infects the sinuses or lungs of such people after fungal spores are inhaled from the air.

This can lead to serious disease with warning signs and symptoms such as:

• Pain and redness around eyes and/or nose
• Fever
• Headache
• Coughing
• Shortness of breath
• Bloody vomits
• Altered mental status

Predisposition

• Uncontrolled diabetes mellitus
• Immunosuppression by steroids
• Prolonged ICU stay
• Co-morbidities – post transplant/malignancy
• Voriconazole therapy

When to Suspect

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• Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone One sided facial pain, numbness or swelling
• Blackish discoloration over bridge of nose/palate
• Toothache, loosening of teeth, jaw involvement
• Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
• Chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms

How to prevent

• Use masks if you are visiting dusty construction sites
• Wear shoes, long trousers, long sleeve shirts and gloves while handling soil (gardening), moss or manure
• Maintain personal hygiene, including thorough scrub bath

DOs
• Control hyperglycemia
• Monitor blood glucose level post COVID-19 discharge and also in diabetics
• Use steroid judiciously – correct timing, correct dose and duration
• Use clean, sterile water for humidifiers during oxygen therapy
• Use antibiotics/antifungals judiciously

DON’Ts
• Do not miss warning signs and symptoms
• Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
• Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology
• Do not lose crucial time to initiate treatment for mucormycosis

How to manage

• Control diabetes and diabetic ketoacidosis
• Reduce steroids (if patient is still on) with aim to discontinue rapidly
• Discontinue immunomodulating drugs
• No antifungal prophylaxis needed
• Extensive Surgical Debridement – to remove all necrotic materials
• Medical treatment
i) Install peripherally inserted central catheter (PICC line)
ii) Maintain adequate systemic hydration
iii) Infuse normal saline IV before Amphotericin B infusion
iv) Antifungal therapy, for at least 4-6 weeks (follow guidelines)
• Monitor patients clinically and with radio-imaging for response and to detect disease progression

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