Mucormycosis Fungal infections if not controlled properly can become dreadful. It is adding suffering in a serious Covid-19 crisis. Infections with mucormycosis, often termed “black fungus”, is seen in many parts of India, in patients who are getting better from the coronavirus. Majority of cases are reported in India for Covid-19-associated mucormycosis documented around the world. The solution of all worldly problems including the toxic illness lies in Sat-Bhakti Sadhana as trained by Sant Rampal Ji Maharaj.
Black Fungus Or Mucormycosis: Key Highlights
- India is battling against the second wave of Covid-19 cases, but fungal infection in coronavirus patients is giving a double setback.
- ICMR and AIIMS have issued fresh guidelines for the identification of high-risk COVID-19 patients for the likelihood of the Black Fungus disease
- The guidelines give a call for strict control of blood sugar and warn against self-medication with steroids, antifungal drugs and antibiotics
- The core reason of mucormycosis or black fungus is the unhygienic way of delivering oxygen and indiscriminate use of steroids in COVID-19 treatment
- Mucormycosis fungi are discovered in soil and on rotting organic material and have potential to infect humans under favorable condition
- A report suggests 94% Covid-19-associated mucormycosis patients had diabetes out of which 67% were poorly treated
What is Black Fungus?
Mucormycosis or black fungus is produced by a mold called Mucormycetes. Mucormycosis, also known as zygomycosis, is the illness triggered by the several fungi of “Mucorales” fungal family. These are found in soil, plants or decaying organic matter. A person engaged in gardening or any outdoor activity, can easily hold it from outdoors to bring indoors. Black fungal outgrowth can be indoors too in rotten food items such as decayed bread or fruits. The fuzzy white mold turns into deep grey on time delay. The black fungus develops its growth in the air conditioners’ condensation lines and drip pans. In short, it is always found in the environment around us in soil, and more often in decaying organic material such as stockpiled food, fruit and vegetables.
Black Fungus Or Mucormycosis: Blunders In Covid-19 Treatment Pose Threats
In exceptionally unusual circumstances the black fungus affects the immune system of compromised patients like uncontrolled diabetic patients or on steroid or cancer patients on chemotherapy. The reports say that only few patients have been reported in India in the last one decade. Then the question occurs why several hundred cases have arisen in patients undergoing or improving from COVID-19. The core reason of mucormycosis or black fungus is:
Cause 1: Unhygienic, Unclean, and Inappropriate methods of oxygen delivery to Covid-19 patients
In comparison to Industrial Oxygen, Medical Oxygen should be highly purified to the tune of 99.5 percent pure. Medical Oxygen is manufactured by compression, filtration and purification processes. The liquid oxygen cylinders should be rigorously cleaned and disinfected. The Medical oxygen should be humid by passing through a sterile water filled container for patients whom high flow oxygen is given for a longer time. Medical oxygen without humidification may dry the mucous membrane and hurt the inner lining of the lungs. There is a possibility of making the sputum or secretion very thick to clear out. Both situations have potential to create turmoil in the patients.
Cause 2: Haphazard dosages and timings of steroids to Covid-19 patients
The use of steroids have been found effective in Covid management, but its dosage and time are very critical. Any miscalculation may increase blood sugar level in diabetic patients. Steroids reduce body immunity and prompt the ill effects of black fungus.
Cause 3: Black fungus poses serious threat in patients suffering or recovering from coronavirus infection
Awkwardly, this fungus is becoming highly risky by killing more than 45 percent of patients, depending upon the seriousness. Amphotericin B Medicine is used to treat black fungus which is highly toxic. Therefore, the solution lies in correcting the oxygen management practices and optimum dosage of steroids.
Black Fungus Or Mucormycosis: Why Is It Damaging Covid-19 Patients In India?
Unlike other countries, India has faced infection from mucormycosis in patients suffering or recovering from coronavirus. The fact is that prior to the coronavirus pandemic India had presence of mucormycosis cases. For example, India had reported 140 cases per million population as compared to 0.6 per million in Australia. Worldwide, occurrences of mucormycosis have happened due to infected products such as hospital clothings, medications and packaged foods whereas India has multiple sources.
ICMR Guidelines For Treatment Of Mucormycosis (Black Fungus)
Evidence Based Advisory In The Time Of Covid-19 (Screening, Diagnosis & Management Of Mucormycosis. (Advisory Developed By The Following Experts & National Task Force For Covid-19)
Courtesy: Department Of Health Research Ministry Of Health And Family Welfare, Government Of India
Mucormycosis (Black Fungus) – If Uncared For – May Turn Fatal
Mucormycosis is a fungal infection that mainly affects people who are on medication for other health problems that reduces their ability to fight environmental pathogens. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air.
This can lead to serious disease with warning sign and symptoms as follows:
- Pain and redness around eyes and/or nose
- Shortness of breath
- Bloody vomits
- Altered mental status
When To Suspect (In Covid-19 Patients, Diabetics Or Immunosuppressed Individuals)?
- Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone
- One sided facial pain, numbness or swelling
- Blackish discoloration over bridge of nose/palate
- Toothache, loosening of teeth, jaw involvement
- Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
- Chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms
- Control hyperglycemia
- Monitor blood glucose level post COVID-19 discharge and also in diabetics
- Use steroid judiciously – correct timing, correct dose and duration
- Use clean, sterile water for humidifiers during oxygen therapy
- Use antibiotics/antifungals judiciously
- Do not miss warning signs and symptoms
- Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
- Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology
- Do not lose crucial time to initiate treatment for mucormycosis
How to manage?
- Control diabetes and diabetic ketoacidosis
- Reduce steroids (if patient is still on) with aim to discontinue rapidly
- Discontinue immunomodulating drugs
- No antifungal prophylaxis needed
- Extensive Surgical Debridement – to remove all necrotic materials
- Medical treatment
- Install peripherally inserted central catheter (PICC line)
- Maintain adequate systemic hydration
- Infuse Normal saline IV before Amphotericin B infusion
- Antifungal Therapy, for at least 4-6 weeks (see the guidelines below )
- Monitor patients clinically and with radio-imaging for response and to detect disease progression
AIIMS Guidelines For Detection And Prevention Of Mucormycosis (Black Fungus)
On Wednesday, AIIMS Delhi issued guidelines for early detection and prevention of mucormycosis in AIIMS’s Covid Ward. AIIMS has announced new guidelines for timely identification, detection and treatment of COVID-19 critical patients from mucormycosis.
The guidelines aim to save lives by listing out symptoms for patients and their caretakers for early detection of mucormycosis to alert medical staff and timely treatments.
Identification Of “High-risk” Patients In The Covid Ward?
The AIIMS pamphlet online says many patients with Mucor are noted to be RTpcr +ve at >10 days from onset. Such patients may stand for immunocompromise connected persistence of COVID infection. Doctors say mucormycosis is found in Covid patients who took steroids to treat symptoms, and they have diabetes and cancer illness. Medical experts have found relationships of diabetes with infection. Further, Covid-19 worsens diabetes and also precipitates diabetes in non-diabetes individuals.
What Should The Patients And The Caretakers Look Out For?
Mucormycosis has a typical set of symptoms:
- Abnormal black color discharge or crusty dryness, or any bleeding from the nose
- Nasal blockage
- Headache or eye pain
- Swelling around the eyes, double vision, redness of the eye, loss of vision, difficulty in the closing eye, inability to open the eye, prominence of the eye
- Facial numbness or tingling sensation,
- Difficulty in chewing or opening the mouth
- Mucor infection of Nose and sinuses indicate the comparatively initial stages infection;
- Timely detection at this stage facilitates early treatment and reduces complications.
- Eye/Orbital mucor infection appear at the moderately advanced stage.
- Intracranial infection is advanced disease – involves cavernous sinuses and cranial nerve palsies occur.
- Caretakers to help the patient consciously conduct regular self-examinations including a full face examination for facial swelling —particularly nose, cheeks, around the eyes—or black discolouration, hardening, and pain on touch in daylight;
- Oral and nasal examinations using a torch to check for blackening and swelling inside the mouth or nose.
What Should A Patient Do Once He Identifies Any Of These Signs?
- Consult an ENT doctor or ophthalmologist for their treatment immediately,
- Do not self-medicate with steroids, antibiotics or antifungal drugs.
- Apprise the doctor about your medical conditions.
- Tell blood sugar levels history, and any immunosuppressive treatments, etc.
- Strict control and monitor blood sugar.
- No self-medication with steroids, antibiotics, anti-fungal.
- If the doctor advises, get an MRI CT scan with contrast – paranasal sinuses and orbit,
Note: Remain vigilant even weeks after recovering from COVID-19 because the Mucor infection may occur during COVID-19 infection, even after a few weeks of apparent recovery from it.
Disclaimer: The article contains the tips and suggestions for general information purposes only and not for professional medical advice. Consult your doctor or a dietician before starting a health improvement program or changing diet.
Pharma Companies Rush To Boost Antifungal Jab Amphotericin B Production
Black Fungus is damaging the nose, eyes, sinuses, and sometimes the brain too. For its treatment Amphotericin B is the primary drug that is highly useful. Due to sudden rise in mucormycosis cases, the demand for Amphotericin B of Liposomal formulation has increased to a great extent.
Pharma companies are making all efforts to increase the production of antifungal drug Amphotericin B injection. The drug is critical for the treatment of mucormycosis. It might take 2 to 4 weeks for enhanced production to reach pharmacy shops. The drug manufacturing process is complex and needs time to release products to the market.
As per sources Sun Pharma has increased the production of Lambin 50 Inj (Liposomal Amphotericin B) to meet the increased demand. Since their technology is advanced, they are using it in their manufacturing process, they will be able to increase their production rapidly.
There Are Few Giants In Amphotericin B Production
Half a dozen companies including Sun Pharma, Mylan, Cipla, Bharat Serums and Vaccines, Intas and Abbott manufacture and distribute the drug in India. During normal situations there is no demand for this drug. Therefore, the pharma companies manufacture the drug in small quantities, may not be exceeding a few thousands of vials.
The pharma companies are in touch with the government for updating their inventory and allocations for distribution on priority. They take instruction from authorities for timely supply. Due to the pandemic situation the doctors, hospitals and stockists are also in regular touch.
Pricing Of The Drug
The drug Liposomal Amphotericin B under brand name Amphonex of BSV has MRP of Rs 6,890 per vial is not now in stock. Lambin 50 Inj (Liposomal Amphotericin B with Sun Pharma’s) price is about Rs 4,739.30 per vial.
Government Controls Distribution
There is an acute shortage of the medicine and the black-marketing possibility has forced the Centre and state governments to become active. Mr. Mansukh Mandaviya, The Minister of State for Chemicals and Fertilizers has taken a note of the situation on May 18 for the need and distribution of Amphotericin B. According to the minister the government has planned a strategy with manufacturers to raise domestic production and simultaneously efforts to import the drug to meet the shortages.
Sat-Bhakti Cures Every Illness
India and all other countries have faced the coronavirus pandemic for over one year. In India in the second wave of COVID-19 it has added more trouble with addition of Black Fungus or Mucormycosis that has made the life of a coronavirus patient more difficult.
Here the idea is to keep each and every one from the community to be happy and free from the sufferings of coronavirus pandemics. It is possible by the adoption of eternal devotion (Sat-Bhakti) directly bestowed by the Supreme Reality Kabir Saheb or His authentic representative Enlightened Sant Rampal Ji Maharaj. It is fortunate that the True Eternal knowledge is given by the enlightened Sant Rampal Ji Maharaj Himself.
How To Strengthen Eternal Knowledge?
Read the sacred book Way of Living and Gyan Ganga to sharpen True Eternal Knowledge. Visit Satlok Ashram YouTube Channel to listen the Sermons delivered by the Jagatguru Tatvdarshi Sant SatGuru Rampal Ji Maharaj.
How To Follow Sat-Bhakti?
Right methodology to remove all suffering is by coming to the refuge of the SatGuru and taking Naam Diksha (Initiation) from Him. The practice of the Eternal Devotion will not only give pleasures in everyday life but also take out from the cycle of birth and death. The real purpose of human birth is to achieve Salvation through Sat-Bhakti. Having enjoyed the fruits of Sat-Bhakti invites other pious souls to take advantage of this life. Once a seeker takes the refuge of the SatGuru, He has the responsibility to fulfill all needful dreams of devotees. No pandemics will make any sort of effect on such disciples of the SatGuru.