The Himachal Pradesh government on Monday issued treatment protocol for Mucormycosis (Black Fungus). A health department official said Mucormycosis is a fungal disease which generally affects the nose, eyes and cerebral area in a human body and the reasons for surge is that Covid-19 infection worsens diabetes, precipitate new diabetes and sometimes develops deficiency of white blood cells.

“The immunosuppressive treatments such as steroids being used in Covid19 patients result in decrease in immunity. Besides, the chronic respiratory disease, intubation, mechanical ventilation and coexistence of other infections during COVID-19 also increase chances of mucormycosis. In addition, uncontrolled diabetes mellitus, immune-suppression by steroids, prolonged ICU stay, comorbidities like malignancy, post transplant are the major risk factors for this fungal disease,” he added.

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He stated that nose and sinuses were the relatively early sites of black fungus infection and the major symptoms include headache, nasal obstruction which was persistent and not responding to medicines, nasal crusting and discharge, pain or loss of sensation over face, discolouration of skin, loosening of teeth, ulceration of palate or bridge of nose, black necrotic eschar in the nasal cavity and sinusitis.

The intra oral symptoms include intra oral pus discharge, ulceration of mucosa, loosening of teeth and unhealed tooth socket, mobility of maxilla.

This fungal disease also affects eyes which can result in swelling and redness of eyes, double vision, loss of vision, pain in the eye, drooping eyelid. He further stated that there were certain laboratory investigations that are done to confirm the disease like blood investigations, nasal endoscopic examination, X-ray, CT scan, biopsy, nasal crust sampling, bronco alveolar lavage etc.

“This disease can be treated by injectable Antifungal amphotericin B and other medicines and the therapy continues until there is a clinical resolution of signs and symptoms of the infection as well as radiographic resolution of signs of active disease. The treatment also includes surgical debridement of the involved tissue. Besides, a regular followup should be ensured in the initial three months,” he said.

He added the disease was preventable and controlling hyperglycaemia, monitoring blood glucose level in post Covid phase, using steroid judiciously, using mask, wearing shoes, long trousers, long sleeves, gloves while handling soil, moss or manure can ensure prevention of this disease.

He also urged that the patients who are on oxygen therapy or are using humidifiers should ensure to use clean sterile and boiled tap water for humidifiers.

The mineral water should not be used and the water should be changed in the humidifier on daily basis, he said, while urging all to remain vigilant on signs and symptoms of black fungus so that a timely medical aid can be sorted for.