, with input from Lifestyle Desk | New Delhi |
June 12, 2021 9:10:57 am
Diabetes and use of steroid-therapy, coupled with COVID-19, results in compromised immune defence of the body; this allows some universally present organisms, to turn dangerous. “Mucormycosis is one such opportunistic infection, caused by some commonly found fungi, belonging to Mucorales group. Beyond this ‘black-fungus’, a much less common ‘white fungus’, and still rarer but more serious ‘yellow-fungus’, have also been observed,” said Dr Ashok Kumar Das, professor of medicine and professor and head of endocrinology, Pondicherry Institute of Medical Science.
He explained that mucormycosis may develop in some patients with COVID-19, particularly in backdrop of increased blood-sugar levels. “It can occur in areas like the ear, nose, throat, face, eyes, brain, and lungs, and has a rapidly progressive course, necessitating urgent care-seeking action. Patients with uncontrolled diabetes, and/or use of high-dose steroids, and other immunosuppressed states, are particularly vulnerable,” Dr Das told indianexpress.com
Let us look at the principles of diabetes care in this context:
Keep blood-sugar levels under control: An essential aspect of countering the risk of mucormycosis post COVID-19, is to ensure sustained blood-sugar control over time, supported by healthy habits of weight-management, exercise, diet-control, stress-management, compliance with medicines, and regular check-ups.
Avoid indiscriminate use of steroids: COVID-19 impairs blood-sugar control in various ways, one of which is the use of steroid-therapy. Appropriate and judicious steroid-therapy as per doctor’s advice, is of paramount importance. Mild-to-moderate cases do not need steroid-therapy; treating physicians administer this when the oxygen saturation drops.
Ensure optimum levels of personal hygiene: These fungi are found in our environment, homes, soil, over decaying rusted iron and zinc material. However, people do not acquire infection unless they are immunosuppressed. This calls for the need to maintain overall personal hygiene, by keeping masks clean and dry, ensuring tidy surroundings, and adequately covering oneself while handling soil, or manure.
Be cautious of the occurrence: A critical aspect of mucormycosis is the rapidity of its progress. Within 1-2 days, the infection may spread from nose, to eyes and brain, resulting in serious outcomes. For timely action, it is important to suspect the possibility of this infection, in presence of pain and redness around eyes or nose, sinusitis, fever, headache, blurred vision, blackish or bloody nasal discharge.
Prevention and treatment of Infection
To overcome the risk of mucormycosis, doctor’s advice on higher antibiotics, steroids, and oxygen therapy, must be followed with utmost diligence. The importance of following preventive measures, as described above, cannot be emphasised enough. If the infection happens, the most appropriate treatment is surgery (involving ENT-surgeon, and Eye-surgeon) and anti-fungal medicine ‘amphotericin-B’, for 4-6 weeks. In my own experience, if an early diagnosis of mucormycosis is made, and with the use of amphotericin-B along-with surgery as needed, results can be considerably better. Early suspicion and diagnosis of mucormycosis, is key to improving disease outcomes.
Building resilience: ‘Survival of the fittest’, has been at the heart of biological evolution. As we evolve through this pandemic, fitness remains the key aspect to realise better health outcomes. Prevention, at all levels, is better than cure. With this understanding, let us pledge to follow healthy practices, in navigating this ‘syndemic’ – a synergistic pandemic of COVID-19 and diabetes.