Don’t blame it on just steroids: Mumbai doctors on mucormycosis cases

The shortest period for getting the fungus among the analysed patients was five days. Representation pic

Is Covid-19 itself triggering mucormycosis? City doctors on the state task force have found cases of the black fungus appearing in less than five to 10 days of Covid-19, which is raising suspicion. Other city doctors say they, too, have witnessed the same. So far, it was believed the indiscriminate use of steroids and water used in the oxygen given to patients are prime reasons for the spike.

Excessive use of steroids and the improper administering of oxygen were considered to be the main reasons behind mucormycosis so far. Representation pic

Dr Vasant Nagvekar, an infectious disease expert at Global and Lilavati hospitals, has analysed the data of 40 mucormycosis patients that he has seen in the last month along with Dr Milind Navlakhe, ENT surgeon, Global Hospitals.

Dr Nagvekar, a member of the task force, said 20 per cent of the patients got mucormycosis on the fifth or within 10 days of getting Covid-19. "A patient complained of severe pain in the cheek region on the fifth day. The pain was unbearable. Twenty per cent of patients got mucormycosis symptoms when they were hospitalised for Covid-19. The shortest period was five days and the longest, as per our data, was 28 days," he said. mid-day has been highlighting how several black fungus cases are being reported and many have lost their vision or suffered disfigurement of the face.

Also Read: Mucormycosis prime concern for Maharashtra, need more medicines: Rajesh Tope tells PM Narendra Modi

The common factor

Dr Navlakhe, who is heading the mucormycosis clinic at Global Hospitals said that around 40 per cent patients got it in the first or second week of Covid-19. "Some patients were at home and did not get much oxygen and yet got the fungus. Some didn't receive steroids and yet got it. The only common factor in our analysis is that all of them had high blood sugar level at some point," said Dr Navlakhe. He added that since the diagnosis is happening late, many are coming with severe infection. "Only three patients from our data had an early diagnosis. We had to remove the eyeballs of three patients and the palate - roof of the mouth that separates the oral cavity from the nasal cavity - of 10 patients," said Dr Navlakhe.

The common factor among all analysed patients was high blood sugar levels at one point in time. Representation pic

Dr Kedar Toraskar, a critical care specialist at Wockhardt Hospital, said he has had a similar observation in his clinical practice in the past month. He said apart from conventional risk factors like diabetes, diabetic ketoacidosis and an immunocompromised state, the Covid-19 virus itself may be an independent risk factor for mucormycosis.

"Mucormycosis is iron friendly and we see a lot of Covid-19 patients with high ferritin (a blood protein that contains iron) levels. This may be one of the reasons for this unique relation that will have to be validated with studies. Also, Covid-19 causes viral endotheliitis (inflammation of the lining of the blood vessels) and mucormycosis spreads via the blood vessels. So this, too, may be a cause," said Dr Toraskar, who is also part of the state task force. He added that this theory was discussed in the weekly task force meeting on Monday. It concluded that early diagnosis is needed to bring mucormycosis cases under control.

Loosening of teeth, pain in the tooth, pus, numbness on the face are the initial signs that must not be ignored, doctors said.

Impure O2 administration

Dr Ravi Wankhedkar, treasurer of the World Medical Association, told mid-day, "Unfortunately, in India, the humidification of oxygen before giving it to the patient is still in practice. During the process, oxygen is administered via a pipe dipped in water in a glass bottle. The patient receives the moisture along with the oxygen. But the water is not sterile or changed frequently. Ensuring its purity can curtail not just black fungus but also many other fungal infections. Also, disposable items attached while giving oxygen, like the mask or the tube, must also be changed every 24 hours. Many don't do that."