Mucormycosis

HEALTH/ GOVERNANCE

Topic:

• GS-2: Science and Technology- developments and their applications and effects in everyday life. 

Mucormycosis

What is mucormycosis?

• Mucormycosis is an aggressive and invasive fungal infection caused by a group of molds called mucormycetes. 
• It can affect various organs but is currently manifesting as an invasive rhino-orbito-cerebral disease, crawling through the sinus and working its way to the brain, affecting the ear, nose, throat, and mouth. 
• While it is not contagious, it can cause a lot of damage internally and can be fatal if not detected early.
• While mucormycosis is an old disease, what is perhaps new and concerning is the sudden increase in the invasive form of the sinus variant, which involves the orbit, and at times the brain, leading to blindness, stroke or death.
• In common parlance, it also goes by the name ‘black fungus’, a direct reference to the blackening that is characteristic of the disease.
• Distinct Symptoms: The signs to watch out for are a stuffy nose, bloody, blackish, or brown discharge from the nose, blackish discolouration of the skin, swelling or numbness around the cheek, one-sided facial pain, toothache or jaw pain, drooping of the eyelids or eyelid swelling, double vision, redness of eyes, and sudden decrease in vision.

Why has it become a cause of concern in recent days?

• Hospitals across the country have started to report a number of cases of mucormycosis, affecting patients who have recently recovered from COVID-19. 
• While no studies exist on the current prevalence, the infection remained a possibility for one in 10,000 persons who recovered from COVID-19. It is predicted that the figure may go up as the number of COVID-19 cases escalates.

What causes the disease?

• Diabetes mellitus is the most common underlying cause, followed by haematological malignancies and solid-organ transplants. Diabetes mellitus was reported in 54% to 76% of cases, according to a report.
• What seems to be triggering mucormycosis in patients post COVID-19 is indiscriminate use of a high dose of steroids in COVID-19 patients, sometimes even in minimally symptomatic patients. This leads to spikes in the sugar level among diabetics, which, in turn, renders them vulnerable. 
• Rational use of steroids is necessary, and constant monitoring of sugar levels and resorting to insulin use to control these levels if required, is essential.
• The use of monoclonal agents like Tocilizumab may be a factor, too. 
• Experts also opine that while the fungi are present in the environment, the use of nasal prongs and other devices for oxygen delivery and possible breach of sterile conditions can possibly lead to cross-infection and hospital-acquired infection

How can mucormycosis be prevented?

• The main line of treatment is an anti-fungal drug called amphotericin B, which is given over an extended period of time under the strict observation of a physician. Surgery to remove the fungus growth might also be warranted.
• Following appropriate treatment protocols as recommended by WHO for COVID-19, including rational use of steroids and monoclonal antibodies only when they can help a patient, is important.
• It is important to keep blood sugar levels under control and ensure that appropriate calibration of oral drugs or insulin is done from time to time.
• Further, recognising the symptoms and seeking treatment early if there are two or three symptoms at a time is key. Like most illnesses, if detected early, mucormycosis can be cured.