Nagpur: 8 operated for mucormycosis, half of them have lost eyesight – ET HealthWorld

ENT specialists, dentists and neurologists are seeing a sudden spike in mucormycosis, a deadly fungal infection, in recovered Covid-19 patients. Use of steroids in treating diabetic patients for Covid-19 is leading to the fungal infection in many cases, say doctors

Nagpur: Eight patients were operated for a deadly fungal infection mucormycosis at a leading hospital in the city in the last 48 hours. At least half of them have lost their eyesight for life.

Doctors – right from infectious disease specialists, head and neck surgeons, intensive care specialists, ENT specialists, dentists, maxillofacial surgeons, neurologists, diabetologists and general physicians – are worried about the sudden spike in mucormycosis cases.

Experts told TOI that this is just the beginning as central India has number of diabetic patients and the extent of Covid-19 infection is such that they need steroids to get over it. Use of steroids is allowing the fungal infection to become active in a patient’s body.

“Mucormycosis is a new, unforeseen challenge and devastating complication of Covid-19 infection. Sinonasal, orbital and rhinocerebral, all types of mucormycosis are on rise in post Covid-19 patients,” said veteran head and neck surgery Dr Madan Kapre.

Dr Kapre further said that treatment planning and execution requires coordinated efforts between ENT surgeons, infectious disease specialists and intensive care experts.

In infectious disease specialist Dr Ashwini Tayade’s words, “It’s raining mucor. It’s really painful to see young and elderly suffering. People are losing their battle to mucor post Covid,” she said.

Dr Tayade stressed awareness, early referral, early intervention, good sugar control, cutting down steroids and reviewing the infection control practices to manage mucormycosis.

Dr Ramakrishna Shenoi, professor & head, Department of Oral & Maxillofacial Surgery at VSPM Dental College, said that low immunity, diabetes and prolonged hospitalization gives fungul infection full chance to attack. “Many of the drugs administered to severely infected patients during Covid-19 are life-saving but may induce the growth of the fungus that can spread into the sinuses present in the facial bones such as maxillary sinus, ethmoidal sinuses, frontal sinus etc and can cause extensive tissue destruction and disfigurement,” he said.

Doctors told TOI that diabetic patients suffering from Covid-19 must keep their sugar under control. They must not ignore symptoms like sinusitis, blackish nasal discharge, facial pain, headaches and pain around the eyes.

“This was not the case in the first wave of Covid-19 in September,” said Dr Chandrashekhar Bande, maxillofacial surgeon and dentist. Most of the patients start experiencing toothache and facial pain and first report to dentists. So, dentists should be aware about the latest developments about this infection.

“As soon as body’s immunity is compromised due to Covid-19 medication, it seizes the opportunity and attacks,” said Dr Bhande.

Long time use of steroids, uncontrolled diabetes and nutritional deflection are the causes of mucormycosis. According to Dr Bhande, one out of 10 diabetic patients who suffers from Covid-19 is experiencing some or the other form of mucormycosis.

The worst is rhinocerebral mucormycosis which starts from the sinuses, and moves very fast to nasal passages, oral cavity, and finally brain. People lose their teeth, jaw, eyes and many bones if this infection is not treated on time.

Maxillofacial surgeons can reconstruct the lost parts of face, but it’s a time-consuming and costly affair. Even treatment for mucormycosis is costly and best way of prevention is to keep blood sugar under control.

Neurologist Dr Dhruv Batra said that diabetic patients who recovered from Covid-19 should not ignore a prolonged headache. “I am coming across unusually high number of patients with mucormycosis in second wave of Covid-19. We conduct the MRI which shows that the fungus is growing rapidly,” he said.

According to Dr Batra, early detection and timely surgical intervention ensures less damage.

Diabetologist Dr Mohan Nerkar said people who are obese, have uncontrolled diabetes and took high dose of steroids are more prone to mucormycosis. “Faulty prone position with high flow oxygen too can leave sinus injured which makes it vulnerable to the fungal infection. I suggest iron depression therapy and anti-fungal medication during Covid treatment and tight control on sugar and steroids to prevent the disease,” he said.

According to Dr (Major) Vaibhav A Chandankhede from ENT department of IGGMCH, it’s necessary to report early for an early diagnosis and evaluation to minimize and control this opportunistic co-infection. “Both medical and surgical treatments are available,” he said.

First case of lungs

The first case of post Covid mucormycosis of lung has been detected on April 30 in Getwell Hospital. Dr Rajesh Swarnakar said that the patient reported with post Covid complaints. “Doctors are giving steroids from day one which is wrong, Steroids are not to be given from day of diagnosis but indicated only when oxygen saturation drops or after a week in case of severe pneumonia,” he said.