NEW DELHI: Steroids have to be used rationally in Covid-19 patients to reduce the risk of mucormycosis, popularly called black fungus infection, if there is a third wave. Dr Ravi Meher, professor in Lok Nayak Hospital’s ENT division, also told TOI on Monday that diabetes patients needed to take extra precautions because mucormycosis was common among diabetics.
Meher said that Lok Nayak Hospital, declared a full Covid facility after the emergence of the infection in April last year, had treated more than 21,000 infected patients during the first and second waves of the pandemic. Among them were 350 individuals who developed mucormycosis, an opportunistic fungal infection affecting chiefly the eye, nose and the brain.
According to a study published by the hospital in the online edition of American Journal of Otolaryngology, a total of 131 patients were confirmed to have mucormycosis between May 21 and June 30 alone during the second wave. Of them, 101 known diabetics.
Out of the remaining 30, who had no previous history of diabetes when investigated, 23 were found to have raised blood sugars in the diabetic range and hence were included in the newly diagnosed Diabetes mellitus category. Steroid was administered to 67 Covid-infected patients who developed mucormycosis.
“Covid itself causes immune dysregulation which predispose to fungal infections but in combination with diabetes mellitus the risk increases many folds,” the doctors pointed out in their research. They added, “Strict blood sugar control, early anti-fungal administration and prompt surgical intervention do reduce the mortality and improve survival outcome as seen in this study which is our ultimate goal.”
The Lok Nayak doctors said they did not find any significant role of oxygen therapy or ICU admission as an etiological factor for the fungal infection.
Mucormycosis is a deadly disease and its management involves the administration of expensive drugs such as Liposomal Amphotericin B, Posaconazole and Voriconazole. In many cases, surgery is also required to prevent the spread of infection. The doctors said several of the patients admitted in Lok Nayak with the fungal infection lost one of the eyes and a few even died despite all medical efforts.
Dr Suresh Kumar, medical director, Lok Nayak Hospital, said that a meeting was held with leading doctors recently to discuss ways to prevent complications associated with Covid management and one of the suggestions was to control the sale of steroids.
“It is an emergency drug and we felt that the steroids shouldn’t be available over-the-counter,” said Kumar. “It should be given only on prescription to prevent the misuse and, therefore, reduce the risks of complications caused by the overuse of steroids.”
