Updated: September 17, 2021 6:20:02 pm
A study conducted on patients from 11 hospitals spread across five states in north India to assess Covid-associated Mucormycosis (CAM) has found out that timely diagnosis along with early surgical and medical management offered them better chances of survival. The study was conducted during the second wave between March and July at units of the Max Healthcare group.
Mucormycosis or black fungus is more common among people whose immunity has been affected due to Covid-19, diabetes, kidney disease, liver or cardiac disorders, age-related issues or those on medication for auto-immune diseases like rheumatoid arthritis. CAM became a disease of epidemic proportions in several Indian states during the second wave of the pandemic.
The study is presently uploaded on Medrxiv and has not yet been peer-reviewed. Its key findings suggest “timely diagnosis along with early surgical and medical management offered better chances of survival for patients in the face of an otherwise fatal disease.” The patients’ records were retrieved from the electronic health records system and their demographic and clinical profile, the hospital course and the outcome were noted.
According to the experts, while diabetes and the use of steroids emerged as clear risk factors, the study suggested that there is a need to explore other causations, including the direct role played by the SARS-CoV-2 virus.
“In moderate and severe cases of Covid-19, the immune system is severely compromised, leading to a severe form of angio-invasive Covid-19 associated mucormycosis (CAM) which has a mortality rate of as high as 80 per cent if a patient goes untreated or remains untreated for long, and even after treatment, mortality could still be 40-50 per cent,” said Max Healthcare’s Group Medical Director Dr Sandeep Budhiraja.
Mucormycosis is caused by a group of moulds called mucormycetes and is a potentially fatal infection if inadequately treated, doctors said. Cases in India contributed to approximately 71 per cent of the global CAM cases based on published literature from December 2019 to the start of April 2021, the healthcare group claimed.
The fungus thrives in uncontrolled diabetics with ketoacidosis as well as in patients with recent steroid use. The most plausible explanation for the recent surge in mucormycosis cases is believed to be the unparalleled, irrational and prolonged use of steroids in Covid patients, the doctor said.
“The Delta variant of the SARS-CoV-2 virus and prolonged ICU stay may be another reason for higher cases of mucormycosis. Use of industrial oxygen in the wake of an acute shortage of oxygen in hospitals may have contributed to this huge case load,” he added.
“A total of 155 cases of mucormycosis were found, either those who were discharged or had died, at the Max network hospital during the period of the study. More than two-thirds (69 per cent) were males. The mean age of the patients was 53.2 years. The commonest symptom (64.5 per cent) in these cases was related to the nose and jaw, most (36.8 per cent) of these had facial pain and paraesthesia. The next common symptom was related to eyes, reported by 42.6 per cent cases. Among other symptoms, the headache was reported by 22.6 per cent and fever by 21.3 per cent,” Budhiraja added.
The patients were classified into “proven, probable or possible mucormycosis” categories, as per the case definition suggested by the European Organisation for Research and Treatment of Cancer (EORTC) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG), the statement said.
For the purpose of the study, the characteristics studied were age, sex, symptoms, disease severity, and presence of diabetes. Details of Covid disease in terms of diagnostic modality, place of treatment (home or hospital), need of oxygen and use of steroids were recorded. The interval between Covid diagnosis and admission to hospital for suspected mucormycosis was also calculated, the statement said.
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