Screening, Diagnosis & Management of Mucormycosis

Screening, Diagnosis & Management of Mucormycosis

Mucormycosis is a fungal infection that mainly affects people who are on medication for other health problems that reduces their ability to fight environmental pathogens.

Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air.

This can lead to serious disease with warning sign and symptoms as follows:

Pain and redness around eyes and/or nose

Fever

Headache

Coughing

Shortness of breath

Bloody vomits

Altered mental status

What predisposes

Uncontrolled diabetes mellitus

Immunosuppression by steroids

Prolonged ICU stay

Co-morbidities – post transplant/malignancy

Voriconazole therapy

How to prevent

Use masks if you are visiting dusty construction sites

Wear shoes, long trousers, long sleeve shirts and gloves while handling soil (gardening), moss or manure

Maintain personal hygiene including thorough scrub bath

When to Suspect

(in COVID-19 patients, diabetics or immunosuppressed indiviuals )

Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone

One sided facial pain, numbness or swelling

Blackish discoloration over bridge of nose/palate

Toothache, loosening of teeth, jaw involvement

Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)

Chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms

Dos

Control hyperglycemia

Monitor blood glucose level post COVID-19 discharge and also in diabetics

Use steroid judiciously – correct timing, correct dose and duration

Use clean, sterile water for humidifiers during oxygen therapy

Use antibiotics/antifungals judiciously

Don’ts

Do not miss warning signs
and symptoms

Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators

Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology

Do not lose crucial time to initiate treatment for mucormycosis

How to manage

Control diabetes and diabetic ketoacidosis

Reduce steroids (if patient is still on) with aim to discontinue rapidly

Discontinue immunomodulating drugs

No antifungal prophylaxis
needed

Extensive Surgical Debridement – to remove all necrotic materials

Medical treatment

Install peripherally inserted central catheter (PICC line)

Maintain adequate systemic hydration

Infuse Normal saline IV before Amphotericin B infusion

Antifungal Therapy, for at least
4-6 weeks (see the guidelines below )

Monitor patients clinically and with radio-imaging for response and to detect disease progression

Team Approach Works Best

Microbiologist

Internal Medicine Specialist

Intensivist

Neurologist

ENT Specialist

Ophthalmologist

Dentist

Surgeon (maxillofacial/plastic)

Biochemist

Straight Talk

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