Double Jeopardy: COVID-19 and Mucormycosis

Updated: April 28, 2021 3:33 PM

Who would have thought that even as we struggle to fight off the Covid-19 threat, another one could emerge in its shadow. Mucormycosis, a serious, potentially deadly fungal infection with a mortality rate of about 50 per cent could become another challenge for us to address immediately.

India accounts for 38 per cent of the global cases reported.

By Dr Ashit Hegde

Who would have thought that even as we struggle to fight off the Covid-19 threat, another one could emerge in its shadow. Mucormycosis, a serious, potentially deadly fungal infection with a mortality rate of about 50 per cent could become another challenge for us to address immediately.

Mucormycosis can be caused by several fungus species that are commonly found in the environment. In the months since Covid-19 struck, we have noticed an alarming two-to-three-fold rise in the number of cases of mucormycosis a majority of which have occurred in people who are recovering from Covid-19. Which means that some of the lives that we have saved from Covid-19 are now succumbing to this serious but treatable fungal infection. This is why it is important for recovering patients and their caregivers to be aware about this infection and know when to seek immediate medical attention.

Under normal circumstances, cases of mucormycosis are relatively uncommon or few because most people with a healthy immune system can easily fight off the infection. Before the pandemic, only people with specific malignancies and patients with poorly controlled diabetes were at a higher risk for this fungal infection. Today, Covid-19 poses an additional threat for the development of mucormycosis.

Why are patients with Covid-19 at a higher risk?

Covid-19 is a relatively new viral infection and this association between Covid-19 and mucormycosis is something that we have only recently observed. There is much that still needs to be researched. However, from what we know so far, there are several factors that are contributing to the increased risk in recovering patients.

In patients with a severe Covid-19 infection, the virus triggers an exaggerated immune response, which leads to high levels of several immune proteins that can cause severe damage in the body. Patients who are hospitalized for Covid-19 are often treated with high doses of corticosteroids and drugs like tociluzimab that also suppress the immune system. This makes patients more vulnerable to opportunistic fungal infections such as mucormycosis.

Moreover, we have seen that patients with diabetes are more likely to have more severe Covid-19 symptoms which may warrant hospitalization. These patients who are already at a higher risk for mucormycosis now have an even higher risk of developing the fungal infection because of their Covid-19. The fungi are able to thrive in the body when blood sugar level is high, and the use of corticosteroids makes it harder to control blood sugar. This combination of diabetes, Covid-19 and use of immunosuppressant treatment is what makes recovering diabetic patients particularly susceptible to mucormycosis.

What can be done to lower the risk and mortality linked to Covid-19 and mucormycosis?

Steroid treatment is essential for patients who are hospitalized for Covid-19. But it needs to be administered in the right dosage and for the right amount of time. Doctors should be careful not to over prescribe steroids or even antibiotics for their patients suffering Covid-19.

It is also important for doctors and patients to be able to recognize the early symptoms of mucormycosis. Symptoms such as sinusitis, pain around cheek or eyes, pain or blackish nasal or sinus discharge, red eye could all be indicative of mucormycosis. If someone you know has these symptoms after a bout of Covid-19 it is essential that they do not delay but get immediate medical treatment at the hospital.

Treatment is available for mucormycosis. Anti-fungal medicines given by IV or orally coupled with surgery to remove the infected tissue can help prevent serious consequences and save a patient’s life. But the key to the treatment being effective is that treatment is given immediately after the symptoms have been identified and this requires a hospital visit at the earliest.

The columnist is Head, Critical Care, Hinduja Hospital, Mumbai. Views expressed are the columnist’s own.

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