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EVIDENCE BASED ADVISORY IN THE TIME OF COVID-19
(Screening, Diagnosis & Management of Mucormycosis)
Mucormycosis – if uncared for – may turn fatal |
Mucormycosis is a fungal infection that mainly
affects people who are on medication for other
health problems that reduces their ability to fight environmental pathogens.
Sinuses or lungs of such individuals get affected
after fungal spores are inhaled from the air.
This can lead to serious disease with warning sign and symptoms
as follows:
| • Pain and redness around eyes and/or nose |
| • Fever |
| • Headache |
| • Coughing |
| • Shortness of breath |
| • Bloody vomits |
| • Altered mental status |
| What predisposes |
| • Uncontrolled diabetes mellitus |
| • lmmunosuppression by steroids |
| • Prolonged ICU stay |
| • Co-morbidities – post transplant/malignancy |
| • Voriconazole therapy |
| 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 |
| When to Suspect (in COVID-19 patients, diabetics or immunosuppressed indiviuals) |
| • Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone |
| • Onesided facial pain, numbnessor 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 |
| 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/antifungais 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, MALDlTOF), 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 antifungai prophylaxis needed |
| • Extensive Surgical Debridement – to remove all necrotic materials |
| • Medical treatment:
o Install peripherally inserted central catheter (PICC line) |
| • Monitor patients clinically and with radio-imaging for responseand to detect disease progression |
| Team Approach |
| • Microbiologist |
| • Internal Medicine Specialist |
| • lntensivist |
| • Neurologist |
| • ENTSpecialist |
| • Ophthalmologist |
| • Dentist |
| • Surgeon (maxillofacial/plastic) |
| • Biochemist |
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