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Sunday, July 25, 2021

After Covid, doctors keep eye out for infections that prey on weak immunity

On Tuesday, Sir Ganga Ram Hospital had reported that it had seen cases of cytomegalovirus, which can cause rectal bleeding, in five patients 20-30 days after they had been diagnosed with COVID.

Written by Sukrita Baruah | New Delhi |
Updated: July 1, 2021 7:04:03 am
At a Covid care facility in New Delhi.

While mucormycosis or black fungus has been the most prevalent, a range of infections which typically affect immunocompromised patients are being reported in people who have had Covid, doctors in the capital say.

Mucormycosis, a rare and potentially fatal fungal infection, was declared an epidemic in the city and over 700 cases have been reported so far. But doctors have been treating other opportunistic infections as well, albeit in smaller numbers.

On Tuesday, Sir Ganga Ram Hospital had reported that it had seen cases of cytomegalovirus, which can cause rectal bleeding, in five patients 20-30 days after they had been diagnosed with COVID.

“The virus exists in 80-90% of the Indian population but the immunity is usually good enough to suppress it. Covid leads to lymphopenia and the additional administration of steroids can suppress the immune system… leading to fertile ground for opportunistic infections,” said Dr Anil Arora, chairman Institute of Liver Gastroenterology and Pancreaticobiliary Sciences at the hospital.

“There’s been mucormycosis, we have seen a case where candida — which is naturally present in the intestine — behaved aggressively and invasively. We have also seen around 20 patients with amoebic liver abscesses,” he said.

However, Dr. Neeraj Nischal, Assistant Professor at the Department of Medicine at AIIMS, is wary of drawing neat lines of connection.

“CMV colitis is a known entity. Although more common in immunocompromised, it has been reported in immunocompetent patients earlier as well. Labelling everything as a post-Covid complication is not right. By the end of the pandemic, crores of people are going to get Covid and then subsequently suffer from other medical conditions which they might have suffered anyway. That does not mean everything is associated with Covid or is a post-Covid sequelae,” he said.

In other hospitals, doctors said that they are keeping their eyes open for such complications.

“I’ve had five cases of CMV pneumonia, and know of other five cases of CMV my colleagues have seen. We took it as something that was bound to happen because of Covid complications and steroid usage. Because of the immunocompromised condition, we need to keep a lookout for these kinds of diseases… Similarly, tuberculosis is resurging again in the country. We’ve already seen a few patients coming in with tuberculosis after Covid, which were being diagnosed as post-Covid syndrome,” said Dr Avdesh Bansal, Senior Pulmonologist at Indraprastha Apollo Hospital.

Dr Jugal Kishore, head of community medicine at Safdarjung Hospital, said tuberculosis is the most important opportunistic infection to look out for. “Whenever there is a huge depression of immunity, the number one infection we see in India is tuberculosis. It takes time to activate — its incubation period is 21 days or longer.”

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