ICMR releases diagnosis and management guidelines for COVID-19-associated Mucormycosis

Several states in India are seeing a rise in cases of black fungus - or ‘Mucormycosis’ - infection in people diagnosed with COVID-19. Such infections are emerging two weeks after a person has recovered from COVID-19. Recently, the Indian Council of Medical Research (ICMR) released guidelines for screening, diagnosing and managing this infection. Mucormycosis, according to the ICMR, is a fungal infection that mainly affects people who are on medication for other health problems that hamper their ability to fight environmental pathogens. In an **interview** with Firstpost, Dr Mala V Kaneria, infectious diseases consultant at Jaslok Hospital and Research Centre, Mumbai, said “Mucormycosis is an uncommon infection, which is caused by mold from the family called Mucorales. This fungus is present everywhere and occurs mostly by inhalation where it enters the sinuses and lungs, or it can enter the body if a person has a burn, cut or abrasion on the skin.” [caption id=“attachment_9627791” align=“alignnone” width=“1280”] A health worker tries to adjust the oxygen mask of a COVID-19 patient at the BKC field hospital in Mumbai, India, Thursday, May 6, 2021.(AP Photo/Rafiq Maqbool)[/caption] She added that the correlation between COVID-19 and Mucormycosis isn’t surprising, as the biggest risk factors for the black fungus infection are uncontrolled diabetes, and steroids, which are known to suppress immunity but are also being used to treat COVID-19 patients. To eliminate this infection, it is important to quickly diagnose the patient as it can be aggressive and life-threatening. It affects the sinuses, eyes and can even spread to the brain. If it affects the eyes, the patient may have to undergo evisceration (disembowelment of the eye), in spite of treatment. A patient is given a combination therapy of antifungal medication and cerebral or surgical debridement. You could have Mucormycosis if you experience a blackish or bloody discharge from your nose, pain in your cheekbones or pain/numbness/swelling on your face; toothache, chest pain and blurred vision are some of the other Mucormycosis symptoms.

What are the symptoms?

• Pain and redness around eyes and/or nose
• Fever
• Headache
• Coughing
• Shortness of breath
• Blood in vomit
• Altered mental status

Who is most at risk?

• Uncontrolled diabetes
• Immunosuppression by steroids
• Prolonged ICU stay
• Comorbidities post-transplant/malignancy
• Kidney disease
• Cancer
• Heart disease

How to prevent the infection

• Use a mask if visiting a dusty construction site
• Wear shoes, long trousers, long sleeve shirts and gloves while handling soil.
• Maintain personal hygiene

ICMR’s things to-do

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

ICMR’s things not-to-do

• Do not miss warning signs and symptoms
• Do not consider all cases with blocked nose to be bacterial sinusitis, especially in the context of immunosuppressors and/or COVID-19 patients on immunomodulators
• Do not hesitate to seek aggressive interventions
• Tests like KOH staining, microscopy, culture, MALDI-TOF can be done to detect fungal aetiology
• Don’t lose crucial time by hesitating to initiate treatment