All you need to know about Mucormycosis: Dos and Don’ts

What is Mucormycosis?

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

Lungs or Sinuses of such individuals get affected after fungal spores are inhale from the air. And this leads to serious disease. Below are the symptoms.

1. Pain and redness around eyes or nose
2. Fever
3. Headache
4. Coughing
5. Shortness of breath
6. Bloody vomits
7. 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?

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

1. Install peripherally inserted central catheter (PICC line)
2. Maintain adequate systemic hydration
3. Infuse Normal saline IV before Amphotericin B infusion
4. 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 progressions.

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