Alarming Life-threatening MUCORMYCOSIS rises in this Covid-19 Pandemic in India

Dr. Reepa Agrawal
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Alarming Life-threatening MUCORMYCOSIS rises in this Covid-19 Pandemic in India 26 Dec, 2020

Mucormycosis is a rapidly progressive invasive infection caused by mucormycetes. This is a rare fungal infection and is seen in immunocompromised individuals. The known risk factors for this opportunistic infection are diabetes, neutropenia, burns, post mycobacterial infection, hematological malignancies, immunosuppression post organ transplant or stem cell transplant. Studies have also shown that iron increases susceptibility to mucormycosis.

Currently there are reports from Delhi, capital of India as well as the western state of Gujarat regarding the rise in mucormycosis cases. According to experts, there are around 8-10 cases per year of this highly fatal disease which has already increased to 47 in state of Gujarat, 13 cases have been reported from Delhi so far. There is a possibility that the immunosuppressive treatment used for COVID-19 is making the patients more susceptible to this disease. A high index of suspicion is vital to rapidly diagnose and treat this disease. This type of saprophytic fungi grow in soil, decaying organic matter including rotten bread. The infective fungal spores can gain entry through nasal passages, cuts or wound in skin. It has 5 types of presentation: rhinocerebral, pulmonary, cutaneous, gastrointestinal, and disseminated. The symptoms depends on site of involvement including unilateral facial pain, nasal congestion, headache, breathlessness etc. As these fungi invade the vasculature, rapid tissue necrosis occurs and hence the increased mortality. The case fatality is close to 50%. However, prompt use of anti- fungal drugs like amphotericin B, posconazole or surgical debridement is essential to reduce morbidity and mortality. Unlike COVID-19 , mucormycosis is not contagious and does not spread from one person to other.

Due to immunosuppression the host becomes susceptible to a wide variety of bacterial, fungal or viral infections. There are vaccines given or prophylactic antibiotics or antifungals started to prevent the same. However in case of mucormycois there is no preventive vaccine available. With the surge in this infection will prophylactic antifungals be prescribed to high risk patients is to be objectively understood. The health advisory department of Gujarat has recommended use of masks, protective gloves, long trousers, shoes when gardening or activities involving contact with soil. As pointed above, a high index of suspicion is essential to rapidly diagnose and treat this devastating disease.



References:

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