Updated: May 15, 2021 6:38:32 pm
AIIMS Director Dr Randeep Guleria Friday warned doctors to brace for cases of mucormycosis, a rare fungal infection, across the country, including among Covid-19 positive persons. He emphasised the urgent need to control and monitor blood sugar levels among Covid patients, with a pattern emerging of more than 90 per cent of mucormycosis patients being diabetics.
Guleria was speaking during a session of a clinical excellence programme to guide state centres of excellence and districts in clinical management protocol.
He said data clearly links the current increase in mycormycosis cases with diabetes and steroid intake. He referred to a meeting he had with doctors from Gujarat where they have reported more than 500 cases of the fungal infection only from government hospitals.
“Hospitals in Gujarat have set up more than one ward just to manage patients with mucormycosis and are now forming combined teams with infectious disease specialists, ENT surgeons, neurosurgeons and plastic surgeons to operate upon these persons… Almost all of the mycormycosis patients had taken steroids. More than 90-95 per cent were diabetics. Covid itself leads to lymphopenia, therefore, predisposing patients to opportunistic fungal infections,” Guleria said.
He said steroid intake can lead to a spike in blood sugar levels.
He also stated they are mapping to see if tocilizumab — an immunosuppressant being used to treat Covid by many doctors — also leads to fungal infections.
Guleria stated that AIIMS Delhi has 18-20 patients who have mucormycosis. He said that unlike in the first wave of the pandemic, doctors are now seeing the fungal infection develop even in patients who are battling Covid.
“We are seeing mucormycosis happening now even when the patient is Covid positive. During the first wave, it would occur later on. Now, we are having two sets of patients: Covid patients with mucormycosis who we are keeping in the Covid ward, and those who become Covid negative and continue to have mucormycosis. And the management strategy becomes even more challenging because of these two sets of patients,” he said.
Dr Yashdeep Gupta, Associate Professor in the AIIMS’s department of endocrinology and metabolism, stressed on the need for screening patients being admitted to a Covid care facility at the time of admission for undiagnosed hyperglycaemia for effective control of diabetes and its consequences during treatment, as well as constant monitoring of sugar levels of diabetic patients and keeping a low threshold for administering insulin.
Guleria remarked on the high number of mucormycosis cases that have been reported in Gujarat and stated, “The focus has to be on preventive aspects: judicious use of steroids and good control of diabetes… Among the cases in Gujarat, around 5-10 per cent patients who developed it were not admitted in hospitals, they were in home isolation and started steroids at home, and then came to hospital with features of mucormycosis… Gujarat is just one state which has picked it up early but I think we’re going to see it in many parts of the country for the simple reason that steroid intake has jumped many times during this second wave.”
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