Finding a containment source key, doctors say-New Indian Express

Express news service

Chennai: Black fungal infections or zygomycosis, a rare but potentially life-threatening fungal attack, are on the rise while the country is fighting the second wave of Covid-19. Recently, the Federal Ministry of Health has requested all states to classify infections as notifiable diseases under the Epidemic Act of 1897.

Certainly there have been such infections in the past, but recent outbreaks have raised many questions due to the high mortality rate seen in Covid-19 patients with fungal infections. In a conversation with The New Indian Express, Dr. V Ashwin Karuppan, a critical care and diabetology consultant at Gleneagles Global Health City, shares his insights.

Q. What are the characteristics of mucormycosis? What are the symptoms of patients with this infection?
The fungus has been around for a long time and affects patients with immunodeficiency, uncontrolled diabetes, chemotherapy, arthritis, and organ transplants. It spreads in the air and enters the sinuses. Symptoms include swelling of the face and eyes, obstruction of the nostrils, brownish or black secretions from the nostrils, low-grade fever, and redness of the face.

Q. Do Covid-19 patients get this infection due to immunosuppression caused by overuse of steroids? Is this related to Covid-19 treatment? If so, how?
Steroids definitely play a role. Administering steroids to Covid-19 patients reduces inflammation in the body. But it’s also a drug that raises your blood sugar. Steroids and diabetes, which cause immunodeficiency, are two main reasons for the development of fungal infections. Therefore, Covid-19 patients are susceptible to fungal infections.

Q. How do fungal infections progress differently in the second and first waves?
First, the first wave didn’t use so much oxygen. At that time, I wasn’t investigating where oxygen was produced, especially industrial oxygen. This can also result from oxygen impurities and the use of old and dirty cylinders. Second, we are using a lot of drugs this time, and the infection has more impact on immunocompromised patients. The cause of mucormycosis needs to be identified to contain the outbreak.

Q. What is the mortality rate for this infection? Does it spread to other parts of the body?
Mortality from advanced zygomycosis is 80 to 90 percent. If the sinuses, palate, and eyes are involved, the entire area should be removed. This is why even treated cases of mucormycosis have a high mortality rate. Infections can also affect the eyes, lungs, intestines, and skin. Treatment becomes difficult when it gets close to the brain and eyes. We have succeeded in treating patients with lung and organ transplants at an early stage.

Q. Does this affect only people with comorbidities, or does it affect healthy young people as well?
People with comorbidities with uncontrolled diabetes are usually most affected. However, young people with immunosuppression can also get the infection.

Q. How important is the drug amphotericin B? How long does this need to be given to the patient? And how much is the treatment cost?
It is an important drug in the treatment of mucormycosis and is usually given in 4 to 6 weeks. However, improper use of the drug can affect the kidneys and other parts of the body, causing more damage than the disease itself. It is also an expensive drug from 7,000 rupees. Resection is also an expensive treatment. Early detection may help with better treatment.

Q. How long is the treatment period for patients with mucormycosis?
About 6-8 weeks is usually sufficient for treatment. In some cases, it can take up to 6 months. It depends on how much fungus is invading. After treatment, check for lesions elsewhere on the body.

Q. How should public health surveillance strategies improvise in the coming years with the simultaneous outbreaks of illness that we are witnessing?
First, you need to identify the source of infection. It doesn’t matter if it’s due to industrial oxygen or not. It is not an infectious disease and spreads only through certain sources of infection. Second, people need to be aware that the infection is there. The government also needs to regulate the use of steroids. Do not use on the left, right or center. They should only be given to those patients who actually need it. The government must also make sufficient amounts of drugs available to treat infectious diseases. Research should be done on where the affected patients came from, how many patients were affected, and where the clusters are. That’s how we fight outbreaks.

Q. What are some of the steps people can take to protect themselves from mucormycosis?
The best way is to stay healthy. Eat a good diet and ensure control of other illnesses such as diabetes. Patients need to know when they need to stop using steroids, and patients need to be aware of the symptoms of zygomycosis. It cures completely.