Mucormycosis - the rising threat in India
27 May 2021
What is Mucormycosis?
Mucormycosis is an infection which is caused by filamentous molds and can be contracted ingestion of contaminated food, inhalation of spores into nares or lungs, or innoculation into disrupted skin or wounds. It is a kind of opportunistic fungal infection.
Who can contract this disease?
mucormycosis occurs primarily in severely immunocompromised hosts such as those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity. Only 6 to 10% of cases occur in subjects with no underlying morbidities. Amidst this pandemic, most cases of mucormycosis is occuring in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma, long ICU stay and have faced immunosuppression following steroid therapy.
Which symtoms to look out for?
Pain or redness around the eyes, fever, headache, coughing, shortness of breath, bloody vomit and altered mental status are possible symptoms of the infection.
What are the confirmatory tests?
A tissue biopsy can be done, it presents with histological appearance with irregular, nonseptate hyphae that branch at right angles.
What are the types?
Based on anatomic localization, mucormycosis can be classified as one of six forms:
(1) rhino-orbital-cerebral mucormycosis (ROCM)
(4) gastrointestinal (GI)
(6) mucormycosis of uncommon sites.
Among diabetics, ROCM is the most common clinical presentation.
Within two weeks of infection, if left untreated may lead to death of patients.
The current guideline for the management of mucormycosis recommends liposomal amphotericin B at a dose of 5–10 mg/kg per day. In the absence of central nervous system involvement, a dose of 5 mg/kg is suggested. Also surgical interventions are suggested.
Why the rise of cases during COVID?
Firstly, hyperglycemia - the traditional risk factor for mucormycosis is aggravated by the most effective therapy for severe COVID-19, namely glucocorticoids. Coexisting respiratory distress syndrome and multiorgan dysfunction preclude timely diagnostic imaging and testing. Finally, the hospitals are overwhelmed by COVID-19 patients, hospitals are short staffed, and essential services, including diagnostics and surgeries, could be significantly curtailed.Hence, the mortality in COVID associated mucormycosis maybe even higher than that observed in non-COVID patients.
Hence, timely intervention in this disease is crucial.In absence of clear clinical benefit , use of immunity compromising drugs should be discouraged.
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