India’s Mucormycosis Threat

Synopsis: There is a high incidence of Mucormycosis in India. Government should urgently look for solutions to limit the incidence of the disease.

Background

• The incidence of mucormycosis (a rare fungal infection) in patients who have been diagnosed and treated for COVID-19 is rising alarmingly in India.
• For instance, according to a study published in Current Fungal Infection Reports the estimated burden of mucormycosis in India is 14 per 100,000. This is almost 70 times higher than what is reported in other countries.
• Even, some States, including Tamil Nadu, have declared mucormycosis as a notifiable disease under the Epidemic Diseases Act.
• Common use of Steroids such as Dexamethasone, methylprednisolone etc., in the treatment of COVID-19 is one of the major reasons for the cause of
• So, to arrest this growing epidemic, Guidelines and protocols need to be adapted and modified rapidly

About mucormycosis

• Causes:
  • The most common cause is uncontrolled diabetes mellitus (raised blood sugars).
  • Other causes include the treatment of some cancers, steroids, chemotherapy or immunotherapy, and solid organ or stem-cell transplantations.
• Occurrence:
  • The common sites of occurrence include rhino-cerebral involvement (i.e., the fungus can damage the nose, paranasal sinuses, the eyes, and the brain), and pulmonary involvement (i.e., the fungus can cause pneumonia).
• Non-contagious:
  • Mucormycosis is not transmissible from one individual to the other.
• Symptoms:
  • Facial swelling on one side,
  • Protrusion of the eyeball,
  • New-onset visual disturbances,
  • Headache and vomiting,
  • New onset swelling or ulcers with blackish discolouration, and prolonged fever.
• Morbidity:
  • Mucormycosis have associations with very high morbidity and mortality.
• Treatment:
  • It requires a multi-disciplinary team approach that includes microbiology, pathology, radiology, and other disciplines.
  • It includes Surgery along with administering of Anti-fungal drugs.

Why mucormycosis is a concern for India?

• First, one of the significant causes for mucormycosis is raised blood sugars and India is home to a large number of Diabetic patients.
  • For instance, according to a study in The Lancet, people with diabetes increased to 65 million in 2016 in India,
  • The highest prevalence of diabetes was observed in Tamil Nadu, Kerala, and Delhi. Further, there is an underlying higher genetic susceptibility to diabetes in Indians.
• Second, apart from this natural cause of Diabetes, SARS-CoV-2 can potentially multiply in pancreatic cells and contribute to increased blood sugar levels in COVID-19 patients.
• Third, during the treatment for Covid-19, there is administration of steroids to lower death rates by reducing the cytokine storm phase. However, steroids when used excessively or prematurely, and without medical supervision can also increase blood sugar levels.
• Fourth, treatment for mucormycosis requires a multi-disciplinary team approach. However, a multi-disciplinary approach is not feasible on a large scale, especially in areas with limited medical access
• Fifth, drugs available are either costly and out of access for the majority of Indians or produce side effects.
• For instance, the standard drug is liposomal amphotericin B. But the price is exorbitant. Whereas, cheap drugs like Amphotericin B deoxycholate have associations with unfavourable toxicity, including kidney problems.

What needs to be done?

• One, Steroid use at home for COVID-19 should be only under the supervision of a healthcare worker.
• Two, monitoring of capillary blood glucose is essential while administering steroids. Health authorities should arrange for blood glucose monitoring for patients at home on steroids.
  • Further, awareness campaigns on the importance of controlled blood sugar levels need to be promoted.
• Three, widespread training of healthcare personnel including Accredited Social Health Activists (ASHAs) to raise awareness on mucormycosis while educating people locally.

Source: The Hindu