ENT specialists, dentists and neurologists notice a sudden spike in mucormycosis, a
Nagpur: Eight patients have been operated on for fatal fungal infection mucormycosis at a leading city hospital in the past 48 hours. At least half of them have lost their sight for life.
Doctors – directly infectious disease specialists, head and neck surgeons, intensive care specialists, ENT specialists, dentists, maxillofacial surgeons, neurologists, diabetologists and general practitioners – worry about the sudden spike in cases of mucormycosis.
Experts told TOI this is just the start as central India has a number of diabetic patients and the extent of the Covid-19 infection is such that they need steroids to overcome it. The use of steroids allows the fungal infection to become active in a patient’s body.
“Mucormycosis is an unforeseen new challenge and a devastating complication of Covid-19 infection. Nasonasal, orbital and rhinocerebral, all types of mucormycosis are on the increase in patients after Covid-19, ”said Dr Madan Kapre, a veteran of head and neck surgery.
Dr Kapre added that planning and executing treatment requires coordinated efforts between ENT surgeons, infectious disease specialists and intensive care experts.
At the infectious disease specialist Dr Ashwini Tayadethe words of: “It’s raining mucor.” It is really painful to see young and old people suffer. People are losing their battle with mucor after Covid, ”she said.
Dr. Tayade highlighted awareness, early referral, early intervention, good sugar control, steroid reduction, and reviewing infection control practices to manage mucormycosis.
Dr Ramakrishna Shenoi, professor and head of the department of oral and maxillofacial surgery at VSPM Dental College, said low immunity, diabetes and prolonged hospitalization give fungal infections every chance to attack. “Many drugs given to patients severely infected during Covid-19 are life-saving but can induce the growth of the fungus which can spread to sinuses present in facial bones such as maxillary sinus, ethmoid sinuses, frontal sinus , etc. cause significant tissue destruction and disfigurement, ”he said.
Doctors have told TOI that diabetic patients with Covid-19 need to keep their sugar under control. They should not ignore symptoms such as sinusitis, blackish nasal discharge, facial pain, headache, and pain around the eyes.
“This was not the case during the first wave of Covid-19 in September,” said Dr Chandrashekhar Bande, maxillofacial surgeon and dentist. Most patients begin to experience toothaches and pain in the face and present to the dentists first. Thus, dentists should be aware of the latest developments regarding this infection.
“As soon as the body’s immunity is compromised due to the Covid-19 drug, it seizes the opportunity and attacks,” Dr Bhande said.
Long-standing steroid use, uncontrolled diabetes, and nutritional deviation are the causes of mucormycosis. According to Dr Bhande, one in 10 diabetic patients who suffer from Covid-19 have some form of mucormycosis.
The worst is rhinocerebral mucormycosis which starts from the sinuses and travels very quickly to the nasal passages, the oral cavity and finally the brain. People lose their teeth, jaw, eyes, and many bones if this infection is not treated in time.
Maxillofacial surgeons can reconstruct lost parts of the face, but it is a long and expensive affair. Even the treatment of mucormycosis is expensive, and the best way to prevent it is to control blood sugar.
Neurologist Dr Dhruv Batra said diabetic patients who have recovered from Covid-19 should not ignore a prolonged headache. “I am encountering an unusually high number of patients with mucormycosis in the second wave of Covid-19. We do the MRI which shows the fungus is growing rapidly, ”he said.
Early detection and prompt surgery guarantees less damage, says Dr Batra.
Diabetologist Dr Mohan Nerkar said people who are obese, have uncontrolled diabetes and take high doses of steroids are more prone to mucormycosis. “A faulty supine position with high flow oxygen can also injure the sinuses, making them vulnerable to fungal infection. I suggest iron depression therapy and antifungal drugs during Covid treatment and strict control of sugar and steroids to prevent disease, ”he said.
According to Dr (Major) Vaibhav A Chandankhede of the ENT Department of IGGMCH, there is a need to present early for early diagnosis and evaluation to minimize and control this opportunistic co-infection. “Medical and surgical treatments are available,” he said.
First case of lungs
The first case of post-Covid pulmonary mucormycosis was detected on April 30 at Getwell hospital. Dr Rajesh Swarnakar said the patient presented complaints after Covid. “Doctors give steroids from the first day, which is wrong, steroids should not be administered from the day of diagnosis but indicated only when oxygen saturation decreases or after a week in case of severe pneumonia”, a- he declared.