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Friday, June 18, 2021

Guleria flags rise in fungal cases, says steroid overuse

According to the Central government, ICMR has begun tracking CAM through its national registry, although the exact case burden is still not known.

Written by Kaunain Sheriff M , Sukrita Baruah | New Delhi |
Updated: May 16, 2021 7:38:59 pm
According to Guleria, AIIMS-Delhi itself has 18-20 patients who have mucormycosis, and they are mapping to see if tocilizumab -- an immunosuppressant being used to treat Covid -- leads to fungal infections. (Express Photo/File)

AIIMS director and member of the country’s Covid task force, Dr Randeep Guleria, said Saturday that several parts of the country are reporting a surge in a supplementary fungal infection known as Covid-Associated Mucormycosis (CAM), which is linked to the “irrational use of steroids” in treatment.

According to the Central government, ICMR has begun tracking CAM through its national registry, although the exact case burden is still not known.

Meanwhile, the task force’s head, Dr V K Paul, defended the Centre’s decision on Friday to extend the interval between Covishield doses to 12-16 weeks. Earlier Saturday, the UK government had reduced the gap between doses of the vaccine from 12 to eight weeks.

Paul said the UK’s data for a 12-week schedule showed that the vaccine was 60-85 per cent effective, and that an analysis by Indian scientists of the data showed signs of reduction in transmission.

On the Covid trajectory, the Centre said that while 24 states have a positivity rate of more than 15 per cent, 17 of them are showing early signs of a plateau in daily new cases.

Guleria, meanwhile, highlighted that hospitals need to focus on “infection control”. “Covid-associated mucormycosis (CAM) is a fungal infection. Earlier, mucormycosis was seen in those patients with uncontrolled diabetes. But the incidence was low. However, due to Covid-19 treatment, we are seeing a significant number of cases. Several parts of the country are reporting an increase in number of cases,” he said during a Health Ministry briefing.

Guleria said CAM has the potential to spread to the brain and “can also result in loss of vision; it also can affect the lungs”. “This time, we are seeing a rise in fungal infection due to two reasons: in many (Covid-19) patients who have diabetes which is uncontrollable, the risk of fungal infection is high; second is the misuse of steroids. Covid patients who are on steroids as well have diabetes have higher risk of fungal infection,” he said.

Guleria said doctors should ensure there is “no misuse of steroids” during Covid treatment. “Those with mild disease, and don’t need oxygen, should not be prescribed steroids. Second, we should ensure that people who have diabetes should keep monitoring their sugar levels. Third, we have to wear masks because it can be found in the air, especially places like construction sites,” he said.

Speaking separately at a clinical excellence programme to guide states and districts in clinical management protocol, Guleria pointed to a meeting he had with doctors from Gujarat where they reported more than 500 cases of the infection only from government hospitals.

“Hospitals in Gujarat have set up more than one ward to manage patients with mucormycosis and are now forming combined teams with infectious disease specialists, ENT surgeons, neurosurgeons and plastic surgeons to operate on these persons… Almost all of the mucormycosis patients had taken steroids. More than 90%-95% were diabetic. Covid itself leads to lymphopenia, therefore predisposing patients to opportunistic fungal infections,” he said.

According to Guleria, AIIMS-Delhi itself has 18-20 patients who have mucormycosis, and they are mapping to see if tocilizumab — an immunosuppressant being used to treat Covid — leads to fungal infections. He said that unlike in the first wave, doctors are seeing the infection develop even in patients who are battling Covid. “During the first wave, it would occur later on,” he said.

On the new vaccination strategy, meanwhile, V K Paul said the decision to extend the interval of Covishield to 12-16 weeks was not taken under pressure.

“It is being trivialised that the decision has been taken under pressure or due to shortage; it is disappointing. The NTAGI (National Technical Advisory Group on Immunisation) has independent scientists…in the UK, the vaccine has been administered to lakhs of people with the three-month protocol. After this schedule was followed in the UK (single dose), in real life, it was found to be 60-85 per cent effective in disease prevention. The protection was found to be even higher in severe disease,” Paul said.

Paul said that the NTAGI decision was based on the WHO’s standard operating procedure.

On the UK’s decision, Paul said it was based on local circumstances and epidemiology. “We have taken our decision based on our epidemiology…looking at our risks, including the pandemic situation or the mutant…we will find out about what has been the scientific basis of their (UK) decision,” Paul said.

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