Mucormycosis has quickly emerged as the next big threat to the country after the second wave of Covid-19 ravaged India and left a trail of bodies behind as a grim reminder of how ill prepared authorities were.
The country at present has nearly 20,000 cases of the serious fungal infection that has already been reported. The mortality of mucormycosis is much higher than Covid-19 and an early diagnosis and prompt management is absolutely critical in saving a patient.
The emergence of mucormycosis is not new during the second wave. Even during the first wave last year, doctors of leading institutes of the country noted the rise of the number of fungal infection cases in India.
The study results were published on June 4 in the reputed Emerging Infectious Disease Journal (Journal of CDC, Atlanta, USA) as ‘ ‘Multicenter Epidemiologic Study of Coronavirus Disease associated Mucormycosis, India’.
Dr Arunaloke Chakrabarti, Professor and head of the Department of Medical Microbiology, PGI, talking in detail about the study, said, “At least 16 healthcare centers across India participated in the MucoCovi Network study that aims to provide detailed information about proven mucormycosis cases with and without Covid-19 infection reported from September 1 to December 31, 2020. The prevalence of Covid Associated Mucormycosis (CAM) was 0.27 per cent in patients managed in hospital wards, and 1.6 per cent in patients managed in ICUs. There was a 2.1-fold rise in mucormycosis cases during 2020 in India compared to the year 2019 and the research suggests that this increase is attributable to the COVID-19 pandemic.”
It was seen that on an average CAM diagnosis was made 18 days after Covid-19 infection. The most common sites of infection were found to be the nose with eye (in 58 per cent cases) followed by nose with eye and brain involvement (27 per cent cases) and then lung infection (nine per cent cases).
It shows a considerable number of patients reported late to the hospital after the disease progressed to their brain. Besides facial pain, nasal blockage and discharge; toothache and loosening of teeth were seen in a high number of cases for the first time.
On comparing cases of CAM with mucormycosis without Covid-19 (Non-CAM), it was observed that uncontrolled diabetes mellitus was the most common underlying disease in both groups.
In patients with CAM, newly-detected diabetes mellitus was more frequent compared to Non-CAM cases (20.9 per cent versus 10 per cent). This suggests the direct role of Covid-19 in causing or worsening diabetes, which may predispose patients to mucormycosis.
In fact, patients with diabetic ketoacidosis developed CAM early i.e. in less than eight days of Covid-19. On the other hand, those patients who developed CAM later had mostly received steroid treatment.
It was observed that inappropriate use of steroids (63.3 per cent), either in very high doses or use in patients who did not need it, was associated with development of late CAM, i.e. more than 8 days after Covid-19 diagnosis.
The overall death rate due to mucormycosis (both CAM and Non-CAM) was 38.3 per cent at 6 weeks and 45.7 per cent after 12 weeks of the illness. It was seen that patients above 54 years of age, those with brain or lung involvement and those who had to undergo ICU admission had a higher risk of death.
The authors concluded that the Covid-19 pandemic has resulted in a rise in cases of mucormycosis in India. Mucormycosis is a critical problem complicating the later part of the clinical course of Covid-19 in India, due to improper glucocorticoid usage.
The rise in the number of cases coincided with the country’s Covid-19 epidemic.
The MucoCovi study is the first evidence-based multicentre look at mucormycosis from India.
The study could remove many myths surrounding the emergence of mucormycosis. Uncontrolled diabetes and improper steroid use are major important factors for the emergence of the fungal infection, though the study could not look into the role of Covid-19 in causing immunity disturbance leading to mucormycosis.
Considering those gaps in the study, the doctors of PGI have planned another large-scale study that will have 30 centres of the country participating in it. They are hopeful to bring out the study results within the next three months.