Madurai, May 2021: “Unusual increase in blood sugar level is a key risk factor of mucormycosis, the fungal infection that is assuming epidemic proportions in many Indian states during the second wave of the COVID-19 pandemic. Hence, diabetic patients who have recovered from COVID-19, being a high risk group, must monitor their blood sugar levels at least three times a day, and for up to six months post COVID-19 recovery,” Dr. S. Gurushankar, Chairman, Meenakshi Hospital – Tanjore, said and added that the patients should seek consultation with doctors without delay when they find anything amiss with their blood sugar level and thus eliminate the risk of the fungal infection or help in its early detection for better treatment outcomes.
In a press statement today, Dr Gurushankar said that patients who have recovered from COVID-19 should not think that it is the end of the crisis. “COVID-19 infection first brings down the immunity level of the body, making it easy for mucormycosis to enter, and then induces the body to produce more sugar and iron, the key nutrients for the fungi, making it easy for the infection to spread. Further the indiscriminate use of oral steroids during the treatment of COVID-19 treatment also has a role in damaging the immune system,” he said.
Dr Gurushankar said that typically patients develop symptoms of mucormycosis – like numbness or pain in one side of the cheek, stuffy nose, and swelling in the eyelid, anywhere from 2-10 days after they test negative for COVID-19 and get discharged from the hospital.
Dr Gurushankar said that mucormycosis caseload in Tamil Nadu is projected to increase manifold in the weeks to come. He pointed out that during the ongoing second wave of the pandemic, COVID-19 cases in Tamil Nadu increased only weeks after the spike in the Northern states. “Today, states like Maharashtra, Madhya Pradesh, and Gujarat are registering 1000s of mucormycosis cases, while it is about 100 in Tamil Nadu. But following the Covid trend, the caseload of mucormycosis is likely to shoot up here later on.”
In preparation of the challenges lying ahead, Dr Gurushankar urged the State government to procure and keep enough stock of antifungal medicines and injections. He also stressed the need for the hospitals treating COVID-19 patients to avoid using unsanitized oxygen pipelines, and contaminated water in humidifiers and oxygen concentrators to prevent the fungal spores from getting into the patients. For the same reason, the hospitals should also avoid repeated use of the same nasal prongs, the apparatus used for delivering oxygen to the nostrils, even for the same patient.
Elaborating on the COVID-19 and mucormycosis connection, Dr. P. Isaac Richards, Consultant ENT Specialist, Meenakshi Hospital, Tanjore, said that COVID-19 creates a pre-diabetic state in many patients. The use of steroids in COVID-19 management decreases neutrophils, the defense blood cells, and makes glucose shoot up to a very high level. These developments shut down the body’s immune system and make it an easy target for fungi.
On the early and later symptoms of mucormycosis, Dr Issac Richards said that unilateral headache, especially at night, that refuses to come down even after taking pain killers, unilateral facial pain, facial swelling, numbness, nasal discharge that is greenish, yellowish, blood stained or blackish, especially after COVID-19 recovery are the initial symptoms. Whereas the later symptoms include unilateral eye swelling, protruding of eyeballs (proptosis), drooping of eyelids (ptosis), double vision (diplopia), loss of vision, blackish discoloration over bridge of nose/palate, loss of teeth, jaw involvement, loss of vision in both eyes, and stroke.
Talking about diagnosis, Dr Issac Richards said that it requires Diagnostic Nasal Endoscopy (DNE) for the diagnosis of mucormycosis. The suspicious tissues must be sent for histopathological examination and culture, and an MRI scan is required to find out the extent of the infection’s spread. And for treating mucormycosis, minimally invasive surgeries are required to debride dead tissues (necrotic tissues) along with the fungus, after which antifungal therapy is provided.
