Kerala, following a directive of the Union Health Ministry, has declared mucormycosis or black fungus infection a notifiable disease under the Epidemic Diseases Act, 1897 as it seems to be emerging as a new threat among COVID-19 patients, especially those who are on steroids (as part of COVID treatment) and whose blood sugar levels are dis-regulated.
It is thus mandatory on all government and private health facilities to report all suspected and confirmed cases of mucormycosis to the Health Department and the Integrated Disease Surveillance Programme (IDSP). These institutions will also have to follow the guidelines for screening, diagnosis, management of mucormycosis issued by the ICMR.
Kerala has so far reported 20 cases of mucormycosis this year, with one confirmed death.
While the number of cases currently reported in the State during the pandemic is not more than the background rate of the disease (rate of naturally occurring disease), it has now become important that the actual burden of the disease is quantified and to check if the proportion of the cases linked to COVID is on the rise, clinicians said.
Mucormycosis is an opportunistic infection normally seen in patients in an immunocompromised state such as HIV, those on long-term steroid treatment, and those diabetes patients with poor glycaemic control. It is not a contagious disease.
COVID has now created a setting wherein the use of steroids, while life-saving for many patients, has also increased the risk of adverse effects such as mucormycosis, especially in those with diabetes and whose glycaemic levels are not carefully optimised.
Though prolonged ICU stay can make patients more vulnerable to this infection, most of the cases reported in Kerala are not in COVID patients in ICUs but in patients with diabetes, who recovered from mild/moderate COVID and had been on steroids.
“Suboptimal control of blood sugar levels, post-discharge, is the primary reason why we are seeing an increase in mucormycosis cases amongst those who recovered from COVID. People who have recovered should continue to monitor their blood sugar levels and ensure tight glycaemic control, so that they do not become susceptible to mucormycosis,” said R. Aravind, Head of Infectious Diseases, Thiruvananthapuram Medical College.
The Union Health Ministry had also said the disease is being detected among patients who are recovering or have recovered from COVID-19.
Steroids are life-saving drugs for COVID patients but it is crucial that it is given to the right patient at the right time and in the right doses. Steroid therapy can play havoc with blood sugar levels and again, tight glycaemic control becomes the key factor which can prevent a person in an immunocompromised state from becoming more vulnerable to mucormycosis.
Director of Health Services R. Ramesh says awareness programmes have already been taken up, asking people not to self-treat with oral steroids. “We have also amped up preventive measures such as meticulous infection control practices in ICUs, maintaining extreme hygiene in handling oxygen masks and cylinders, training physicians on the judicious use of steroids. We are also taking steps to stock the drug Amphotericin-B,” he says.
