“The efficient management and prudent use of steroids in the treatment of COVID-19 are key.”
India has the highest levels of mucus in the world, with 140 cases per million people. Therefore, the country expects a tidal wave of infections in the coming months.
The country that has most diabetics after China has to face the challenge of fighting the invasive fungal infection, says professor and head of the neurology department at Guntur Medical College and the Government General Hospital in Guntur. NV Sundarachary.
According to medical studies, 38% of symptoms occurred during treatment for COVID-19 and 62% in the follow-up period.
“A study on the pathophysiology of invasive fungi in COVID-19 shows that immunodeficiency after COVID-19 predisposes to secondary infection. The hyperglycemic state in COVID-19 induces damage to the pancreatic cells, which leads to acute diabetes due to the high expression of ACE 2 receptors in pancreatic islets. Steroids and immunosuppressants used in COVID-19 treatment are also predisposed to invasive fungi, “said Dr. Sundarachary.
Common symptoms
“Black fungus is eukaryotic, has no flagella and spreads through spores. While headache is the most common symptom, loss of vision due to optic nerve involvement cannot be ruled out. The infection can cause basal meningitis and cranial neuropathy after intracranial extension. The smaller the size, the more it causes meningitis. In contrast to acute bacterial infections, fungal infections are subacute to chronic and sluggish. All fungi are not ubiquitous as bacteria, ”he said.
But the good news is that most mushrooms are not harmful to humans, but most fungi do cause infections in immunocompromised people. Mucormycosis is a fungal infection that involves rhinoceros, sinus, orbital, and brain tissues.
It is commonly seen in patients in India and especially immunocompromised patients undergoing cancer treatment.
Reasons
“The reasons are irrational use of steroids, uncontrolled diabetes, lymphopenia in COVID-19 and contamination from oxygen humidifiers. While pneumonia is rare in COVID-19 patients, aspergillosis is a common companion, ”he said.
“Black crusts in the nasal cavity, discharge from the nasal cavity, swelling and numbness of the sinuses are the first symptoms. When it spreads to the orbit, the symptoms are proptosis, swelling and redness of the orbit and eyelids, blurred vision and ophthalmoplegia, “said Dr. Sundarachary.
The neurological symptoms are headache, facial pain, swelling and numbness, double vision, sinus thrombosis, loss of vision, focal cerebral lesions, mostly stroke, facial paralysis, seizures, and altered mental state.
Diagnosis is made by clinical, radiological features, and confirmation is made by staining with KOH and / or histopathological examination.
Since this is a medical emergency, early treatment improves survival. However, early surgical removal of necrotic lesions and antifungal therapy can reduce the risk, he said.
“The key message for prevention is the use of steroids in the treatment of COVID-19 in the right patient, at the right time, in the right dose for the right duration, and efficiently monitoring and treating hyperglycemia,” said Dr. Sundarachary.