ICMR issues advisory on 'black fungus' among COVID-19 patients, lists do's and don'ts

The Centre on Sunday said that 'Mucormycosis' a fungal infection detected in COVID-19 patients with uncontrolled diabetes and prolonged intensive care unit (ICU) stay, is likely turn fatal if uncared.

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New Delhi: The Centre on Sunday said that 'Mucormycosis', a fungal infection detected in COVID-19 patients with uncontrolled diabetes and prolonged intensive care unit (ICU) stay, can likely turn fatal if left uncared.

In an advisory prepared by the Union Health Ministry and ICMR — which is evidence-based, called for the screening, diagnosis and management of the disease. 

The government said mucormycosis is a fungal infection that mainly affects people who are on medication that reduces their ability to fight environmental pathogens.

"Mucormycosis, if uncared for, may turn fatal. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air," the advisory stated.

Evidence based Advisory in the time of #COVID-19 (, & ) @MoHFW_INDIA @PIB_India @COVIDNewsByMIB @MIB_India #COVID19India #IndiaFightsCOVID19 #mucormycosis #COVID19Update pic.twitter.com/iOGVArojy1

-- ICMR (@ICMRDELHI) May 9, 2021

Warning symptoms include pain and redness around eyes and nose, fever, headache, coughing, shortness of breath, bloody vomits and altered mental status, the advisory stated.

Major risk factors for this disease include uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, malignancy and voriconazole therapy, the ICMR-health ministry advisory stated.

The disease can be managed by controlling diabetes, discontinuing immunomodulating drugs, reducing steroids and extensive surgical debridement- to remove all necrotic materials, according to the advisory.

DO'S
* Control hyperglycemia

* Monitor blood glucose level post COVID-19 discharge and also in diabetics

* Use steroid judiciously – correct timing, correct dose and duration

* Use clean, sterile water for humidifiers during oxygen therapy

* Use antibiotics/antifungals judiciously

DON’TS
* Do not miss warning signs and symptoms

* Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators

* Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology

* Do not lose crucial time to initiate treatment for mucormycosis

Medical treatment includes installing peripherally inserted central catheter, maintaining adequate systemic hydration, infusion of normal saline intravenously before Amphotericin B infusion and anti-fungal therapy for at least six weeks besides monitoring the patient clinically with radio imaging for response and to detect disease progression, it said.