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Increasing cases of Mucormycosis or black fungus infection is being reported among COVID-19 patients during the treatment or after recovery. The combination of diabetes, Covid, and steroids is seen as the reason behind the outbreak of mucormycosis across the country. But doctors are also seeing a steep rise in the number of other fungal infections such as aspergillosis among intensive care units and Covid-recovered patients, along with mucormycosis. And the same diabetes-Covid-steroids combination is said to be fuelling the rise in aspergillosis, a rare invasive fungal infection just like mucormycosis.
Doctors are consciously limiting the early use of steroids to lower the chances of secondary infections and suggesting not to start steroids at home and monitor blood sugar levels daily in patients on steroid therapy.
Zen Multispecialty Hospital in Mumbai has reported two cases of aspergillosis and four cases of mucormycosis.
A 62-year-old male patient with a history of blackish discharge from the right side of the nose for 15 days, suspected to be mucormycosis, visited Zen Multispeciality Hospital. However, on examination, the doctors found no black eschar in the nasal cavity, which is the hallmark of mucormycosis. The patient also complained of cough and hoarseness. On nasal endoscopy, whitish fungal material was spotted in the nose and the material found was sent for KOH mount and fungal culture, which confirmed the diagnosis of Aspergillosis. A laryngoscopy was also performed which detected fungal debris in the voice box. CT scan of his chest showed multiple cavities in both the lungs. His sputum was tested which confirmed invasive aspergillosis, an infection caused by a type of mold (fungus), the hospital said in a statement.
Another 50-year-old man was admitted to the ICU at the same hospital owing to post-covid lung fibrosis and pneumothorax (collapsed lung). There was no black discharge or black crust that is seen in mucormycosis. His nasal endoscopy was done and fungal debris was spotted that again showed aspergillosis.
The doctors at the hospital noted that there may be many patients who are battling this unknown fungal infection.
Aspergillosis is a fungal infection caused by aspergillus, a common mold (a type of fungus) that lives indoors and even outdoors. Most people breathe in Aspergillus spores every day without getting sick. But those with weakened immune systems, having uncontrolled diabetes, organ transplant recipients, one with certain types of blood cancer, those taking steroids, or having lung diseases are at a higher risk of developing health problems due to aspergillus, said Dr. Shalaka Dighe, ENT Surgeon, Zen Multispeciality Hospital, Mumbai.
Now, there is a sudden and alarming increase in the occurrence of invasive aspergillosis. "Steroids reduce the inflammation in the body, but also suppress immunity. We are now routinely doing a nasal endoscopy for all post-covid patients admitted at Zen Multispeciality Hospital for the early diagnosis of invasive fungal infections before they spread to the eye or brain," Dr. Dighe stated.
According to Dr. Dighe, an anti-fungal drug called Voriconazole is commonly used for the treatment of aspergillosis. But, in these patients, voriconazole was not given as it can lead to a flare-up of mucormycosis. The nasal material in these patients also showed (aseptate fungi) mucor on KOH mount. But the fungal culture only grew Aspergillosis. Mucor was probably a contaminant in these cases.
"We used a newer anti-fungal called Isavuconazole to treat these patients, as it works against both mucormycosis and Aspergillosis. They will also have to undergo endoscopic sinus surgery to clear the fungal material from the sinuses. Both the patients are stable now, and there is no involvement of the eye and brain. Though, these patients will take some time to get back on track," Dr. Dighe added.
Fungal infections like mucormycosis and Aspergillosis are not novel or new like the Coronavirus, but there is an alarming rise in the number of cases, warned doctors at Zen Multispeciality Hospital.
Dr. Dighe said that post-Covid patients especially the ones who have received steroids or long-term broad-spectrum antibiotics or have had a prolonged hospital stay should monitor their blood sugar levels to keep them under control. They should also look for red flags like eye pain, swelling of the eyes and cheek, nose block, cheek pain, and abnormal discharge from the nose, and consult an expert once anybody notices these symptoms, he suggested.
"Invasive fungal infections such as mucormycosis have been associated with higher morbidity and mortality rates. Now, aspergillosis is also increasingly picked up among post-Covid patients. Avoid taking steroids for more than 10 days with good blood sugar control as it can invite fungal infections. The usage of steroids should only be under the supervision of the doctor. Avoid self-medication if you have diabetes or have undergone organ transplant to avoid aspergillosis," concluded Dr. Roy Patankar, Director and Gastroenterologist, Zen Multispeciality Hospital.
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