Surge of Mucormycosis among covid 19 patients
Covid Mucormycosis `Black Fungus`
Just as we are in middle of latest wave of covid cases in Nepal , neighboring India has surge of opportunistic Black Fungus infevtion –Mucormycosis which has infected few of nepali patients as well.
Though India is the mucormycosis capital of the world, the 8,000 cases in less than two months have shocked the medical community. Doctors have called on the Indian Council of Medical Research to study the reasons for the ‘outbreak’ of mucormycosis, which is a rare but serious fungal infection caused by moulds called mucormycetes. While the combination of the coronavirus, diabetes and steroids is being talked about as the big factors, these are common across the world and it is only in India that mucormycosis has emerged as an epidemic.
Global prevalence of mucormycosis varies between 0.005 and 1.7 per million population, but its prevalence in India is nearly 80 times higher (0.14 per 1,000).
Mucormycosis mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.
Indiscriminate use of steroids, especially on patients with diabetes or those whose immune systems are already weak, puts them at a high risk of an opportunistic infection like mucormycosis, say doctors.
Covid-induced diabetes that goes unchecked post discharge is also a reason for increase in cases of mucormycosis, say doctors. Covid triggers diabetes as it affects the functioning of beta cells in the pancreas that produce insulin. Steroids also induce diabetes. This results in low immunity leading to fungal infection.
Some experts believe that mucormycosis in patients who have recovered from Covid-19 could be due to use of industrial oxygen for medical purposes and, in others, due to patients sharing oxygen cylinders.
Unlike medical grade oxygen, industrial oxygen is not sterile, say some doctors. Sharing of cylinders among patients due to high demand could have compromised the hygiene of the cylinders, say doctors. Contaminated water used in the humidifier could be another reason, according to a report submitted to the Karnataka government.
In March 2020, when the pandemic began in India, zinc supplements emerged as the chosen ‘immunity boosters’, rising to become one of the country’s highest selling drugs in 2020. Research over the decades has shown that metal zinc acts as a growth factor for fungus, especially mucormycosis.
Given the tremendous pressure on hospitals, sanitisation may have not been proper. Unsterilised medical equipment, prolonged use of the same mask, tubes and beds can be a source of infection too.
As for treatment, the dermatophyte is amenable to liposomal amphotericin B . but the drug itself is now scarce in Nepal and India and in some places has fallen into black marketeers. Critical care specialists and Ent surgeons are advocating early referral and biopsy which can be done even outside Kathmandu.
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