Immunity suppressing medicines for prolonged duration in COVID-19 treatment increases risk of mucormycosis

Immunity suppressing medicines for prolonged duration in COVID-19 treatment increases  risk of mucormycosis

What are the key substances used in the COVID-19 treatment that causes black fungus infection?

High doses of immunity suppressing medicines for prolonged duration in COVID-19 can increase risk of mucormycosis in COVID. Drugs like steroids, at high doses, immunosuppressants like Tociluzumab, baricitinib, bevacizumab and tofacitinib can predispose an individual to mucormycosis.

There is a direct link of mucormycosis found with poorly controlled sugar level (high sugars) in patients, prolonged use of immunosuppressants and prolonged hospital stay.

What are the key insights on the incidence of mucormycosis in diabetics?

Diabetes in itself is a disorder with a weak immune response. When sugars are very high, the innate immunity is further hit and allows for opportunistic fungi like mucor to harbor and grow. Likewise diabetic patients with better controlled sugars have very less chance of getting black fungus infection.

Invasion of sinuses may cause swelling in one side/or rarely both sides of the face. Drooping of eyelid and eyeball, fever, drowsiness, altered sensorium, etc can be seen in case of mucor infection.

As far as the treatment regime is concerned, the experience so far shows that liposomal amphoterisin and/or posaconazole coupled with aggressive debridement of sinuses may help save patients.

Any data on the number of diabetics suffering from mucormycosis after recovery from COVID-19?

It is hard to give a percentage as last year the mucor infection was relatively rare, and it is only during the second wave that we are seeing increased numbers of this fungal infection. mucormycosis can be prevented by strict sugar control and in high risk COVID patients by giving prophylactic drugs like posaconazole.

 

Author is Chief Consultant Physician, Diabetologist, Department of Internal Medicine, Virinchi Hospitals, Hyderabad

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