Now, a shortage of anti-fungal injection in Mumbai

Since mucormycosis was a rare disease, nobody stocked a lot of the Amphotericin B shots needed for it; now, pharma companies ramp up production and govt has taken over its distribution

After remdesivir, steroids and oxygen, the city is facing a shortage of an anti-fungal injection — Amphotericin B — used to treat mucormycosis, the black fungal infection hitting an increasing number of Covid-19 patients and those who have recovered. mid-day had earlier reported about several cases of mucormycosis where patients lost their vision or suffered facial disfigurement.

The fungal infection affects the nose, cheekbones, eye orbit and then the brain. Representation pic

Suddenly, the demand for Amphotericin B has gone up. Earlier, it was not even five per cent of the current demand. Some time is needed to produce the medicine. We are told that seven pharma companies are relentlessly working to meet the demand,” said Prasad Danave, president, Retail and Dispensing Chemists Association.

Danave said that there is no stock in the market and supplies coming in are being distributed through government channels “The government is analysing the situation and in coordination with the Food Drugs Administration (FDA), distributing it to hospitals,” said Danave.

In the pre-Covid-19 era, mucormycosis was a rare disease seen in immunocompromised patients. It is caused by a group of moulds known as mucormycetes naturally present in the environment. They invade the facial bones, the eye orbit and can spread to the brain rapidly. The disease has a 70 per cent mortality rate, which means seven out of 10 patients die.

ICMR gives guidelines

The Indian Council of Medical Research (ICMR) has formed guidelines on the screening, diagnosis and management of mucormycosis. The state, too, is forming a multidisciplinary team comprising an internal medicine expert, ENT surgeon, infectious disease expert and an endocrinologist to manage the disease and bring numbers down.

Dr Shashank Joshi, a consultant endocrinologist at Lilavati Hospital and a member of the state Covid-19 Task Force, said, “The task force is mindful of the rise. The key is prevention and early diagnosis. While treating Covid-19, steroids need to be given in the right dosage and for the right time to ensure they taper off.”

Once the infection progresses, surgery or long term anti-fungal treatment is the only solution. “There should be strict sugar control and mouth, nose, and throat hygiene in diabetic patients, the oxygen administered must be in distilled or sterile water,” Dr Joshi said.

Private hospitals like Global Hospitals in Parel have started a clinic dedicated to mucormycosis. Dr Milind Navlakhe, ENT surgeon heading Global Hospitals’ clinic, said, “We have 25 patients admitted with mucormycosis. One of the patients is a 60-year-old woman whose eyeball will have to be removed to save her.”

‘Free treatment, regulation of cost of meds’

People covered under the state’s Mahatma Phule Public Health Scheme will be treated free of cost for mucormycosis. The medicine required in its treatment is very expensive. Health Minister Rajesh Tope said on Monday that the department has taken serious note of the disease. “Diabetic Covid-19 patients, who don’t control their sugar properly, are largely affected by mucormycosis,” Tope said from Jalna. The minister said he received complaints of overcharging from patients who needed the injection for treatment. “We will regulate the prices of drugs needed for mucormycosis and treat patients at 1,000 hospitals that provide free treatment under the state public health scheme,” he said.
— Dharmendra Jore

What to watch out for

>> Pain, redness around the eyes or nose, with fever, headache, coughing, shortness of breath, bloody vomits, altered mental status
>> Sinusitis — nasal blockage or congestion, nasal discharge (blackish/bloody)
>> Local pain on the cheekbone, one-sided facial pain, numbness or swelling
>> Blackish discolouration over bridge of nose/palate
>> Loosening of teeth
>> Blurred or double vision with pain, thrombosis, necrosis, skin lesion

70%
Mortality rate for mucormycosis, which means seven out of 10 patients die

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