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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)
o Maintain adequate systemic hydration
o Infuse Normal saline IV before Amphotericin B infusion
o Antifungai Therapy, for at least 4-6 weeks (see the guidelines below )

• 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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