Mumbai Metropolitan Region (MMR) has seen 987 mucormycosis cases till date, of which 294 cases are from the city, while 693 are outside Mumbai. Moreover till date, 205 people have succumbed to mucormycosis, of which 61 occurred in the city. However, since the third wave started, doctors have hardly seen any mucormycosis cases. Doctors believe there has been a tremendous drop in the cases of mucormycosis over the last two to three months. These reasons include a “controlled and low dose of steroids”, “strict control and check of blood sugar level in admitted patients during treatment”, and following “strict quality of oxygen humidification protocols”.
Commonly known as black fungus, mucormycosis is caused by a group of molds called mucormycetes that are present in the environment. These fungi attack humans who are battling illnesses such as Covid-19, when the body’s immunity is at its lowest. A large number of mucormycosis cases have been seen in Covid-19 patients, who had undiagnosed diabetes or had uncontrolled sugar levels while undergoing the treatment.
According to doctors, people have stopped self-medicating and have reduced the use of steroids or antibiotics which had become rampant during the second wave of Covid-19 last year — has also contributed to the dip in cases.
Dr Milind Navlakhe, ENT surgeon, Global Hospitals, who has seen two cases recently said, one of the patients was a 60-year-old who had a blood sugar of 600. While he had mucormycosis, there was no confirmation on whether he had COVID-19. He got operated elsewhere. The other patient only came to the OPD and didn’t follow up.
“it is too early to comment on mucormycosis cases in the third wave. During both the waves, the mucormycosis patients came after two-three months. In the third wave, we have not seen much hospitalisation and use of steroids. We are hoping there won’t be many mucormycosis cases,” said Dr Navlakhe.
Dr Mala Kaneria, Dept. Of Infectious Diseases, Jaslok Hospital & Research Centre said Mucormycosis is a complication or a secondary infection, which can occur in COVID patients, both post recovery from COVID and also during the stage of active COVID, just within 5-6 days of onset of the first symptoms of COVID. The reasons are multifactorial such as the presence of high blood sugars (caused by the virus itself, steroids and underlying diabetes mellitus), immunosupressants like steroids and Tocilizumab and possibly something to do with the iron metabolism, given that mucor needs iron for growth and the fact that mucormycosis has also been observed in patients of mild COVID who have not received either oxygen or steroids.
“Mucormycosis is an uncommon infection which is caused by mold from the family called Mucorales.THis occurs mostly by inhalation where it enters the sinuses & lungs, or it can enter a body if a person has burn , cut or abrasion on the skin.To eliminate the infection it is important to quickly diagnose the patient as it can get aggressive .It affects the sinuses, eyes , & can even spread to brain. A patient is given a combination therapy of antifungal medication & cerebral & surgical debridement,” she said.
According to research carried out by doctors at Lilavati and Fortis hospitals in Mumbai, steroids, if used under strict protocol and with tight control of blood sugar levels, can totally avoid the occurrence of mucormycosis.
“The low-dose steroids were administered as per state government protocol for treating Covid-19, a nurse-driven strict glycemic control regime (blood glucose level was maintained through the admission in ICU) and it was concluded that a strict adherence to protocol of low-dose steroids coupled with strict glycemic control helped in eliminating the risk and incidence of mucormycosis in a tertiary care dedicated Covid-19 hospital,” says the study, published in the journal Diabetes and Metabolic Syndrome: Clinical Research and Reviews.
Recently Wockhardt Hospital, Mumbai Central is treating a 70-year-old man who was tested positive for COVID-19 on January 5 and admitted to the hospital on January 12 with blood sugar as high as 532. His nasal swab tested positive for mucormycosis.
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