India is gripped with COVID- 19 infection that has affected almost 3.7 million people throughout the country. The estimated 5-7% of positive patients require hospitalization requiring oxygen support. Unfortunately, few of the COVID-19 treated or recovered patients are suffering with another fatal infection known as Mucormycosis and is commonly called– Black Fungus. This is another challenge in fighting against the COVID-19 threat.

The different steroid preparations such as dexamethasone, prednisolone or methylprednisolone at suggested dose are the mainstay for the treatment and management of moderate to severe patients. But doctors treating coronavirus patients are prescribing variable doses of these steroids. Several anti-microbial agents are also prescribed to treat and prevent pulmonary infections causing pneumonia.

Many of the COVID-19 patients suffer from comorbidities. India is the epicentre of diabetes with approximately 80 million diabetics. Their care is of particular importance in the current scenario of pandemic. COVID treatment with steroids and immune-suppression in conditions such as old age, cancer chemotherapy or radiotherapy, organ transplant recipients on immune-suppressors are well recognized co-morbid conditions.

The immuno suppressive state becomes favorable for opportunistic fungal infections. As pergillus, which is omnipresent in the atmosphere and Candida which is a resident of the human body are the most frequent fungal infections seen in immune-suppressed people. 

Mucor is another common infection and difficult to treat. Mucormycosis, known as Black Fungus as it forms black lesions in the infected area. Mucor infects the deeper tissues that generally start from sinus and then extend to the eyeball involving the bone and the soft tissues, eventually reaching the brain tissues. Mucormycosis is dreadfully morbid as it causes rapid deterioration of eyes and can lead to permanent loss of vision. Once Mucor reaches the brain, the patient starts deteriorating faster leading to paralysis, organ failure, complications and death.

Each and every patient who is discharged from hospital should be warned to be alert of the early symptoms of Mucormycosis. The symptoms include, blood stained or black discharge from the nose with localized pain and redness on the cheek-bone or palate. There is redness of eyes, headache and fever also. The doctors should carefully be suspicious about this infection and start the management without losing any time.

For diagnosis of this infection, if possible, biopsy (endoscopic or CT guided) is taken for microbiology or serology or molecular identification. If it is suspected strongly, then anti-fungal is started without losing any time.

Infection by Mucor is usually deep seated making early diagnosis very difficult. The ideal approach is to start antifungal drugs immediately and extensive debridement of all infected necrotic tissue if possible, should be carried out. In case of advanced infection to the brain, the only option is to give aggressive suitable antifungal drugs.

The main strategy is to give effective antifungal drugs as early as possible with optimal dose for optimum duration till the infection is cleared clinically and microbiologically.

As per the Global Guidelines on Treatment of Mucormycosis by European Confederation of Medical Mycology, the choice of anti-Mucor drugs is restricted only to three molecules – Amphotericin B, Posaconazole and Isavuconazole. Out of these, Isavuconazole and Posaconazole are recommended if there is pre-existing renal compromise.

The rational use of steroids and antimicrobials in coronavirus patients with early diagnosis and start of treatment with Liposomal Amphotericin B and continuation till the clearance of infection can save many lives.

Source: ET Healthworld