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Doctors warn of severe post-COVID secondary infections

Ram (name changed), 36, tested positive for COVID on April 18. He had mild symptoms and consulted a doctor over the phone, who prescribed him regular COVID-19 treatment — paracetamol, vitamin and mineral supplements. On the sixth day, however, his fever soared to 102-103° Fahrenheit; his blood reports indicated severe inflammation and the doctor now also prescribed him oral steroids.

Though the steroids reduced the inflammation and brought down the fever, they aggravated his diabetes, which had been borderline before the infection. Over the next few days, he had to be put on insulin as his blood sugar levels could not be managed by oral medication. But that was not the end of his troubles.

Also read | ‘Mucormycosis is still a rare occurrence’

A few days later, he complained of pain in the right eye, swelling and numbness in the right cheek, and an excruciating headache. His doctor called him to the hospital. On examination, they found a black gangrene kind of infection in his nose. He was immediately admitted to the hospital. A biopsy of the nose tissue revealed mucormycosis. He was put on strong antifungal drugs but since the infection had already spread to his eyes, nose and cheek, doctors had no choice but to remove his right eye to prevent it from entering his brain.

“It was a life-saving surgery. Though the surgery has caused cosmetic disfigurement, had the infection entered his brain, it would have been difficult for us to save him,” said Manish Munjal, consultant ENT surgeon, Sir Gangaram Hospital, Delhi.

Dr. Munjal added that mucormycosis — a rare fungal infection — has cost many COVID-19 patients their vision, jawbones, nose. “In some, it has even led to severe neural complications,” he said.

Mucormycosis or black fungus infection is caused by a group of moulds known as mucormycetes, which are present in the air and damp places. Doctors have now confirmed a rise of 50% more cases compared to that in the previous years.

Also read | ‘Diabetics must immediately approach doctor if they have symptoms of mucormycosis’

“You can spot this fungus in the inner surfaces of water tanks which have not been cleaned for a while or other damp areas. In a normal person, the body’s own immunity is quite capable of fighting it off but in people with compromised immunity, uncontrolled diabetes, the fungus enters through the nostrils and grows. It may grow rapidly in the nose, cheeks, penetrates the jaws, the lungs, and even the brain,” explained Dr. Arun Sharma, a community medicine expert and director, National Institute for Implementation Research on Non-communicable Diseases, Indian Council of Medical Research, Jodhpur.

The experts blame it on the low-immunity levels of COVID-19 patients who are prescribed steroids.

Also read | Telangana releases guidelines for control of mucormycosis

“Steroids are a preferred treatment for COVID-19 patients who develop severe inflammatory response during the second phase of the disease. But steroids, when given too early, too much and for too long, can make one susceptible to catching secondary bacterial or fungal infections,” explains Dr. Samiran Panda, head, department of epidemiology and communicable diseases, ICMR, Delhi.

The infection, doctors say, is more common in patients with uncontrolled diabetes, and the elderly. It manifests as black spores in the nasal cavity. When it penetrates the brain, it may lead to an altered mental state in the patient, who may suffer hallucinations, epileptic attack; when it spreads to the jaws, the infection can loosen the teeth. In the lungs, it can cause severe pneumonia with symptoms such as severe chest pain, cough, breathlessness, and in the eyes, a loss of vision.

It mostly strikes after two weeks of treatment — after a patient is discharged from the hospital in moderate cases or in patients suffering from severe illness and are in the intensive care unit for long time, where they are on immune-modulatory drugs, essential in the treatment of COVID-19.

“If detected early, it can be treated effectively with the anti-fungal drugs readily available in the market. The doctors must be alert and look for early signs. In severe cases, however, to save the life of a patient, doctors may have to choose a more aggressive mode of treatment, including surgical removal of the part affected,” says Dr. Sharma.

He adds that a doctor has to stay alert. “Also, at the time of the discharge, doctors must educate the patient about the possibility of secondary infection and how to spot it early,” notes Dr. Sharma.

With several cases of mucormycosis being detected in Delhi, Maharashtra and Gujarat, experts in the National COVID-19 Task Force have issued an evidence-based advisory on the disease. The task force has noted that along with the treatment of mucormycosis, it is important to monitor and manage a patient’s blood sugar level, reduce steroid use, and discontinue immuno-modulating drugs.

Experts have also cautioned that a patient should not discontinue the treatment for mucormycosis before 4-6 weeks, or as advised by the doctor, to rule out the possibility of re-occurrence of the infection.

They have said that it is important to keep COVID patients’ oxygen mask and canula sterile to prevent mucormycosis. Doctors say it is necessary to keep a regular check on water used in oxygenation for any possible contamination and examine the nostrils and skin of the patients for an early sign of infection. Besides, a patient also has to take certain precautions post-COVID. It is advisable to avoid damp and dusty places for a while. If one cannot avoid them, one should wear a three-ply mask, gloves, and fully cover one’s legs and arms.

“It takes 3-4 weeks for the effects of steroids to wear off after a patient stop taking them. During this period, the patient is susceptible to catching not only fungal infection but also other viral and bacterial infections. We have seen a lot of cases of secondary pneumonia, urine infection, tuberculosis post COVID-19. So, it is important to maintain personal and environmental hygiene,” said Dr. Munjal.


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Printable version | Jun 14, 2021 12:08:26 AM | https://www.thehindu.com/news/national/doctors-warn-of-severe-post-covid-secondary-infections/article34572159.ece

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