Mucormycosis is the latest woe in India’s COVID fight. The fungal infection, which often turns fatal, is triggered by the overuse of steroids in severe COVID patients with comorbidities such as diabetes, cancer or other immunocompromised conditions. Since the infection is highly dangerous, killing between 46% to 96% of the patients, and often leads to complete blindness if not death, it is better to prevent it by taking due care in treatment protocol and maintaining proper hygiene in ICUs and the whole hospital environment, says Dr V Mohan, Director & Chief of Diabetes Research at Madras Diabetes Research Foundation, and Chairman & Chief Diabetologist, Dr. Mohan’s Diabetes Specialities Centre, in Straight Talk.
There is an assumption that certain drugs, including steroids, used for COVID treatment lead to the infection among diabetics. So is it right to say that diabetics are more prone to the infection and if yes, which is the particular drug substance that causes the same?
Steroids in general cause an acute increase in blood sugar levels by countering the action of insulin. It is known that people who have high blood sugar levels are prone to all types of infections including bacterial, viral and fungal. So, in a way it is important that special care is taken in case of diabetes patients while treating for COVID-19 where steroids are used with no particular therapeutic regime yet evolved for critical cases.
What correlation do you see in patients with high blood sugar levels and mucormycosis?
High blood sugar reduces the immunity of the individuals and hence dangerous fungal infections like mucormycosis can spread rapidly in people with uncontrolled diabetes. At the same time, I would also like to clarify that it is not the drugs used for diabetes which leads to the infection, but the use of steroids for COVID severity that causes the fungal infection.
What are the key insights/experiences on the incidence of mucormycosis for immunocompromised patients?
From past experience, it is people with uncontrolled diabetes who are most prone to mucormycosis. Other causes include the use of steroids, malignancies, chemotherapy drugs and drugs like deferoxamine which are used for iron overload conditions. All these have been linked to higher incidence of mucormycosis. In people who have diabetic ketoacidosis (coma), the risk of mucormycosis is very high.
What are the particular symptoms of mucormycosis found in diabetics?
The symptoms of mucormycosis in COVID patients with underlying medical conditions are more or less the same, whether it is in people with diabetes or without diabetes. It starts off like an ordinary cold and then the sinuses get infected with blackish material. This then spreads to the eye, which then gets inflamed and becomes red. Later, there is swelling and protrusion of the eyeball and if this is severe, it may lead to the need for removal of the eye itself. Finally it can enter into the brain and if this occurs, it is usually fatal.
What kind of special treatment is available for the treatment of mucormycosis in diabetics?
The first thing to do is to get the diabetes under very good control. Secondly, specific antifungal drugs like Amphotericin B are used. These are however quite toxic and also expensive. In severe cases, removal of the jaw or the eye may become necessary. Hence, it is always better to prevent mucormycosis than try to treat it after it occurs.
As a diabetologist and an avid researcher in this area, do you have any perspective or data about the size of the diabetic population currently suffering from mucormycosis post COVID recovery?
Most of the cases of mucormycosis are immediately referred to the ENT surgeons or to the ophthalmologists because flu and sinusitis or impaired sight and blindness are the symptoms that are manifested first. If the sugars are uncontrolled, some of the patients get referred to us for the control of diabetes. Till COVID occurred, mucormycosis was extremely rare and one or two cases per year were seen. Now, after COVID, a large number of cases have been reported from Mumbai and Ahmedabad and they are also now being seen in Delhi, Tamil Nadu, Andhra Pradesh, Karnataka and other states as well. Most cases of mucormycosis occur in those with severe diabetes.