Mucormycosis risk mitigation in the COVID battle
Why in News
- With the emerging Pandemic in all over the world, it causing many side-effects to those who are already suffering from various disease such as older age, obese, having uncontrolled diabetes, heart or respiratory diseases and malignancies.
- According to the collected data, 70%-80% affected with COVID-19 recover without many side-effects, about 20%-30% of patients affected with symptomatic COVID-19 might require hospitalization, a minority section can get worse and require treatment in an intensive care unit (ICU).
- The new fear after the treatment of COVID-19, especially in an ICU setting, is contracting a severe disease known as mucormycosis.
- It is a rare, fungal infection caused by a group of fungi known as mucormycetes.
- Mucormycosis usually affects people who have poor immunity, and uncontrolled diabetes have the highest risk of developing it.
- Other risk factors of mucormycosis include steroid treatment, those who have malignancies, HIV/AIDS and those who have been treated with medicines such as deferoxamine for iron overload conditions.
- Heavy doses of steroids to patients who do not have diabetes may be vulnerable to contract it and it substantially raise blood glucose levels in diabetic people. This sets the scene for the development of mucormycosis.
Types and diagnosis
- One of the common types is rhino-orbital-cerebral mucormycosis.
- This starts as a common cold or sinusitis, but soon spreads to the eyes producing redness of the eyes, and later bulging of the eyes known as proptosis.
- It may eventually lead to paralysis of some of the eye muscles, or even to blindness.
- It can also spread to the brain, and if this occurs, the prognosis is very grave.
- Other forms of mucormycosis include the pulmonary form in which the lungs are mainly involved and less common cutaneous mucormycosis or disseminated mucormycosis, where it spreads throughout the body.
- If the body diagnosed early and aggressive treatment given.
- Antifungal drugs such as Amphotericin B are used, but they are quite toxic and also expensive. Sometimes if the case is grave it may need a surgery.
Sugar control, steroid use
- It is important for diabetic people to keep their sugar levels under very good control.
- The dose of antidiabetic drugs will have to be adjusted and, in most cases, insulin would be needed to keep the sugars under control throughout the day.
- Meticulous hygiene and care of the equipment inside the ICU including oxygen tubes and ventilators should be done in order to reduce the risk of fungal and other infections.
- Usage of steroids reduce one’s immunity and may actually increase the risk of developing COVID19.
- Also, in the initial phase of viremia (medical term for viruses present in the bloodstream), the use of steroids can actually disseminate the virus widely, thereby worsening the COVID19 infection.
- It is only when the cytokine storm is suspected, (which usually occurs in the second week of the COVID19 infection) that steroids should be used, and that too with discretion.
Monitor blood glucose
- Patients who were put on steroids for COVID19, their blood glucose levels are not adequately monitored, leading to extremely, and often dangerously, high blood glucose levels.
- This can also precipitate diabetic ketoacidosis — a classic situation where the more dangerous forms of mucormycosis
- Those who treating COVID19 infection must pay equal importance to the control of diabetes.
- Healthy protein diet and fully vaccination is must for them as vaccination will ensure that the risk of developing severe COVID19, requiring hospitalization and thus the risk of developing dangerous infections such as mucormycosis, can be drastically reduced.
- Frequent monitoring of sugar levels should be done by using a handheld, blood glucose meter.
- It is possible to wear a small sensor patch on the upper arm which can continuously monitor a person’s blood glucose levels and thus keep it under good control throughout the day.
- If proper importance is not given to monitoring of blood sugar levels while giving steroids during the treatment of COVID-19 it can lead to extremely dangerous high blood glucose levels.
- This can also precipitate diabetic ketoacidosis — a classic situation where the more dangerous forms of mucormycosis occur.