Mucormycosis, an invasive fungal infection of the sinuses in Covid-19 patients, has become a cause of concern for hospitals across the state, owing to the short supply of the life-saving drug Amphotericin-B in its liposomal form. Across eight key hospitals in five cities of Gujarat, there are at least 1,163 patients undergoing treatment at present.
The rapid spread of the infection, also called black fungus, has meant an increase in the number of daily surgeries. Doctors say that while early detection increases the chances of recovery, many patients developing mucormycosis continue to be Covid-19 positive, leaving little or no chance for treatment.
On Monday, the Gujarat High Court, while hearing a suo motu public interest litigation (PIL) on Covid-19, referred to the rise of mucormycosis cases as “a very serious issue” and sought details from the state government through its counsel, advocate general (AG) Kamal Trivedi, on how it plans to ensure sufficient stock of the antifungal drug.
Dr Vishala Pandya, superintendent of Gujarat Medical Education and Research Society (GMERS)-run Gotri medical college hospital in Vadodara, said, “We are getting Amphotericin B from the Gujarat Medical Services Corporation Limited (GMSCL). It is available in batches but if the number of infected patients increases in the coming days, it will be a problem… The regular version of the drug, which is more freely available in lyophilised powder form, is not recommended for patients with comorbidities. One patient requires close to 120 injections for long-term treatment…”
AG Trivedi submitted before the division bench of Justices Bela Trivedi and Bhargav Karia that the state has placed orders for 1,24,430 vials of Amphotericin B in both liposomal and lyophilised form, of which 26,000 are of the preferred liposomal variety that costs about Rs 2,000 more than its lyophilised form. The AG submitted that the state will bear the cost of approximately Rs 15 crore.
“As of today, we (state government) have sufficient stock… The injections are not easily available as the manufacturers are few in numbers… Whatever had happened with Remdesivir (shortage) may occur with Amphotericin-B but the state government is trying to cover the requirement,” the AG submitted.
While advocate Amit Panchal during the hearing suggested the state to make mucormycosis a notifiable disease, as the state of Haryana has, Dr RS Trivedi of PDU Hospital in Rajkot, who is also a member of the national taskforce of mucormycosis, said that the national taskforce of mucormycosis has not yet suggested to the state government that the fungal infection be declared as a notifiable disease. “This is under the ambit of the taskforce of community medicine experts who study the disease and make recommendations (to the state government),” says Dr Trivedi.
The Gujarat HC sought that the state government files an affidavit before the next hearing scheduled for May 26, detailing a roadmap on the antifungal drug distribution.
Rajkot & Jamnagar
The Rajkot civil hospital has 400 mucormycosis patients at present. Dr Trivedi said, “Most of them require surgery but there are some patients who have had their surgery at a private hospital and are currently admitted here to get Amphotericin-B administered.”
However, Dr Trivedi says that the OPD as well as IPD (new admissions) in Rajkot has seen a “50-60 per cent decline in the number of patients with mucormycosis in the past two days. “It is possible that the cyclone has discouraged people from coming to the hospital, but we see it as an encouraging sign. The hospitalisation for treatment of mucormycosis is long, with a minimum of four to eight weeks and thus we have not discharged any patient yet,” Dr Trivedi says.
At GG Hospital at Jamnagar as 77 mucormycosis patients against 40-odd patients last week, said Dr SS Chatterjee, nodal Covid-19 officer at the facility.
In Ahmedabad, officials say there is a spurt in SOS calls for Liposomal Amphotericin over the usual medical oxygen, Remdesivir injection, or even oxygen beds. “We received over 100 enquiries for Liposomal Amphotericin in around 10 days…,” says Dr Meet Ghonia, founder of ‘Swastham’ social media platform created by intern doctors and medical students.
At the Medicity campus in Asarwa, three new wards were added on Sunday to the existing four. Doctors said there are more than 400 patients with mucormycosis at the Medicity campus alone.
Madhish Parikh, a volunteer of Gujarat Covid Support, said, “We have been receiving more than 50 SOS queries for Amphotericin B injection over the past one week. Now patients have also started asking or tablet posaconazole, an alternate of Amphotericin B.”
In Vadodara, SSG hospital and GMERS Gotri are the two government facilities that are witnessing a surge of cases of mucormycosis from various parts of the state as well as neighbouring states.
While SSG has 112 patients, GMERS Gotri has 30 cases of mucormycosis. SSG hospital, which records up to 12 admissions a day, recorded one death of mucormycosis and one discharge.
Medical officer of Health, Vadodara Municipal Corporation (VMC) Dr Devesh Patel said, “We have tried to centralise the figures for the district but the cyclone has delayed the process. Early detection helps but many cases that come at an advanced stage are difficult to handle.”
Dr Pandya of GMERS says, “We have had cases of patients who developed mucormycosis while they were undergoing treatment for Covid-19… in such cases, it is difficult to treat the fungal infection. We are yet to see complete recoveries…”
In Surat there are 144 cases of mucormycosis undergoing treatment at the New Civil Hospital (64 patients), SMIMER hospital (30 patients) and Kiran Hospital (50 patients), while one confirmed death and one suspected death due to mucormycosis have been recorded till date.
Dr Bhavin Patel, ENT surgeon at Kiran Hospital, said, “One male patient with mucormycosis died 20 days ago. We have a pending list of 75 patients from different parts of Gujarat and neighbouring states such as Madhya Pradesh and Maharashtra.”