Centre issues guidelines for management of black fungus disease in children below 18 years

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The Director General of Health Services (DGHC) under the Union Health Ministry on Wednesday issued guidelines for the management of mucormycosis or black fungus disease in children below 18 years.

As per the Ministry of Health and Family Welfare (MoHFW), mucormycosis is a serious fungal disease seen in patients with underlying/predisposing factors such as immunosuppression, poorly controlled diabetes mellitus, misuse/overuse of steroids, cancer, organ/stem cell transplantation, and those under prolonged ICU treatment.

"Do not wait for culture results to initiate therapy as mucormycosis is an emergency. Early complete surgical debridement is the cornerstone of treatment, and maybe repeated as required," the DGHC said in its guideline.

According to the guidelines, "Conventional Amphotericin B as a prolonged IV infusion through a central venous catheter or PICC; closely monitor kidney function and electrolytes during treatment. Reconstitute in water for injection, and dilute in 5 per cent dextrose (do not use normal saline/Ringer's lactate, start with test dose: 1 mg IV infusion over 20-30 minute. Loading dose: 0.25-0.5 mg/kg IV infused over 2-6 hours; gradually increase by 0.25 mg-increments/day to reach maintenance dose: 1-1.5 mg/kg/day."

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"Liposomal Amphotericin B or Amphotericin lipid complex, if available; prolonged infusion over 2-3hours through a central venous catheter or PICC and closely monitoring KFT and electrolytes. Reconstitute in water for injection, and dilute in 5 per cent dextrose (do not use normal saline/Ringer's lactate); start full dose from first day; 5 mg/kg/day (10 mg/kg/day in case of CNS involvement)," it said.

"Posaconazole should be given as salvage therapy in cases who cannot be given Amphotericin B. Children less than 11 years in age dose - 7-12 mg/kg/dose IV twice on the first day and maintenance dose - 7-12 mg/kg IV once a day, starting on the second day," it added.

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