New Delhi: Amid an alarming rise in the number of black fungus cases across the country, the All India Institute of Medical Sciences (AIIMS) has issued a new set of guidelines for the identification of high-risk patients in the COVID-19 ward and to protect them from deadly mucormycosis.
‘Black Fungus’ or ‘mucormycosis’ is a rare fungal infection. It is caused by a fungus named mucor, which is found on wet surfaces. Cases of mucormycosis are rapidly rising among COVID-19 survivors, causing blindness or serious illness and even death in some cases, health officials have warned.
The guidelines issued by AIIMS list out signs for which patients and their caretakers must keep a lookout for early detection of black fungus or mucormycosis so that medical staff is alerted on time and timely treatments save lives.
The new guidelines were released by AIIMS’ Dr Rajendra Prasad Centre for Ophthalmic Studies for early detection and prevention of mucormycosis in AIIMS’s Covid Ward.
The AIIMS COVID Portal has a complete brochure on Mucormycosis, recognition of onset and treatment by doctors.
Who are the “high-risk” patients in the COVID ward?
The AIIMS pamphlet online says many patients with Mucor are noted to be RTpcr +ve at >10 days from onset. This may represent the immunocompromise-related persistence of COVID infection.
According to doctors, cases of mucormycosis, also known as black fungus, are being seen among Covid patients who were administered steroids to treat symptoms, and particularly among those who are suffering from diabetes and cancer. Medical experts have pointed to strong links between diabetes and infection.
Also, Covid-19 has a tendency to worsen diabetes and also precipitate diabetes in previously normal individuals.
The “high risk” COVID patients to be monitored are:
-Patients with uncontrolled diabetes, diabetic ketoacidosis, and diabetics on steroids or tocilizumab
-Patients on immunosuppressants or anticancer treatment, and patients with a chronic debilitating illness
-Patients on high dose steroids and/or long duration of steroids or tocilizumab
Severe Covid cases
-Patients on oxygen support—nasal prongs, by mask, or on a ventilator
-Ophthalmologists have been asked to conduct a baseline examination of these high-risk patients, followed by weekly examinations till the time of discharge.
The guidelines also stress on follow-up examination, depending on the patient’s condition either every two weeks for six weeks, or once every month for three months.
What are the symptoms for early detection of black fungus?
-Nose bleeding, abnormal black discharge
-Nasal congestion
-Head and eye pain
-Swelling near the eyes, blurred vision, red eyes, less visibility, difficulty in opening and closing the eye
-Numbness or tingling feeling on the face
-Difficulty in opening the mouth or chewing something
-Toothache, swelling inside or around the mouth
What to do if you have symptoms of black fungus?
AIIMS has also laid out guidelines on what to do if a patient shows symptoms of black fungus
-Contact an ENT doctor immediately, contact an eye expert or contact a doctor who is treating a similar patient
-Follow the treatment every day. If you have diabetes, then monitor blood sugar
-If there is any other disease, keep taking medicines and monitor it
-Do not take steroids or any other medicines on your own. Take medication only after consulting the doctor
-Get MRI and CT scan done on the advice of the doctor. The nasal-eye examination is also important
How it can be treated?
This infection can be treated via intravenous (IV) medication or through surgery. A patient infected by Black Fungus generally needs a type of injection for 21 days. The basic cost of this injection is around Rs 9,000 per day. During the first phase of the COVID-19 pandemic, the fungal infection typically came to light a couple of weeks after patients were discharged, Dr Hetal Marfatia, professor and head of the ENT department at the government-run KEM hospital in Mumbai. Niti Aayog Member (Health) V K Paul had on Friday said that mucormycosis cases were being found in patients with COVID-19.
VK Paul said, “When a patient is on oxygen support, it should be ensured that water does not leak from the humidifier (to prevent the growth of the fungus).” He also called for “a rational usage” of steroids and medicines such as Tocilizumab to treat COVID-19 patients.
Black Fungus declared ‘Notifiable Epidemic’
Amid the growing number of mucormycosis or ‘black fungus’ cases across the country, several states have declared it a notifiable disease under the Epidemic Diseases Act 1897. These states include – Rajasthan, Gujarat, Telangana, Tamil Nadu, Odisha, Karnataka, and Assam.
It may be noted that the Centre had on Thursday urged the states and Union territories to make black fungus or mucormycosis a notifiable disease under the Epidemic Diseases Act, 1897, stating that the infection is leading to prolonged morbidity and mortality among COVID-19 patients.
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