Study will look at Covid cases from January to June and identify risk factors other than diabetes & uncontrolled use of steroids. PGI now seeing a slow decline in the number of cases of mucormycosis, with 5 to 8 daily cases.
Now PGI is all set to do a 27-centre case control study across India, looking at cases of COVID-19 between January and June 2021, and identifying those who developed mucormycosis and those who did not. The study’s primary aim is to understand the risk factors, other than diabetes and uncontrolled use of steroids.
“It will be an intensive study. WHO has agreed to sponsor it and work on the ethical clearance has already started. It will take about three months to complete the study and another three to publish it. It will give us a lot of much-required insight into the risk factors associated with mucormycosis,” said Dr Arunaloke Chakrabarti, Professor and head, Department of Medical Microbiology, PGI, and an authority on the subject.
Earlier this month, under the leadership of doctors at PGI, a study entitled ‘MucoCovi’ (Muco from mucormycosis, Covi from COVID-19) was conducted at 16 centres across the country. The study results were published on June 4 in the reputed Emerging Infectious Disease Journal (Journal of CDC, Atlanta, USA) as ‘Multicenter Epidemiologic Study of Coronavirus Disease associated Mucormycosis, India’.
Sixteen healthcare centres across India participated to provide detailed information about proven mucormycosis cases with and without COVID-19 infection reported from September 1 to December 31, 2020. “The prevalence of Covid Associated Mucormycosis (CAM) was 0.27% in patients managed in hospital wards and 1.6% in patients managed in ICUs. There was a 2.1-fold rise in mucormycosis cases during 2020 in India compared to the year 2019 and the research suggests that this increase is attributable to the COVID-19 pandemic,” the Prof says.
It was seen that on average CAM diagnosis was made 18 days after COVID-19 infection. The most common sites of infection were found to be nose with eye involvement (in 58% cases), followed by nose with eye and brain involvement (27% cases) and then lung infection (9% cases). It shows a considerable number of patients reported late to the hospital after the disease progression to the brain. Besides facial pain, nasal blockage and discharge; toothache and loosening of teeth were seen in a high number of cases for the first time.
Dr Chakrabarti said the cases of mucormycosis have started going down slowly. “From about 500 to 600 cases daily across the country, the number has come down to about 300. For about a month, we have been looking at 10 to 15 new cases in PGI, but now the number is between 5 and 8. Apart from the cases of COVID-19 going down, I feel there is now a more rational use of steroids; still the numbers are high, as compared to the world. Earlier, more cases were recorded in Maharashtra and Gujarat, and then it was Delhi and north of India.”
Prof Chakrabarti says it will take some time for the cases of mucormycosis to come down, as we are two to three weeks behind COVID-19. While new cases are decreasing, from 4 lakh across the country to around 60,000 now, the mortality is still around 2,000. “So as mortality will take about two to three weeks to come down, similarly, the COVID discharged are now vulnerable to mucormycosis, especially patients in serious condition. So mucormycosis will also take about this much time. The crisis of drugs to treat mucor is now easing out, though not over.”
During the second wave of COVID-19 pandemic, more than 20,000 serious fungal infection, mucormycosis cases were reported across India, with the mortality of mucormycosis much higher than COVID-19 infection. An early diagnosis and prompt management, says the doctor, is paramount to save lives.
Prof Chakrabarti says the need of the hour is to study COVID-19 Associated Pulmonary Aspergillosis (CAPA), which has emerged as a major issue, with 10 per cent patients in the ICU developing CAPA, and no study or focus on it in India. Aspergillosis is an infection caused by Aspergillus, a type of fungus that lives both indoors and outdoors, with illnesses caused due to aspergillosis affecting the respiratory system, with varied signs and severity. Aspergillus can cause serious disease in people with weak immune systems, underlying lung disease, and asthma.
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