Steroids to beat the virus could bring on the fungus11 May 2021
Health experts are saying that they are seeing increased cases of Mucormycosis (MM), also known as black fungus among covid recovered patients due to increased use of steroids during their covid treatment.
Dr. H K Susheen Dutt(ENT Senior Consultant, Fortis Hospital Bannerghatta Road) talks of a 70-yeat-old patient being treated with steroids for covid, "He did not have any history of diabetes mellitus. Towards the end of two weeks, though his covid symptoms improved, he had a nose block and there was swelling near his eyes. Over the next three to four days, his vision deteriorated. He could not see even 12 inches from his face. That is when he came to us with a significant progression of Mucormycosis as observed in the MRI scan. He underwent radical sinus debridement with removal of the right eye, followed by aggressive antifungal treatment in the form of intravenous Amphotericin B."
There has been a rise in the numbers of patients showing mucormycosis symptoms, especially in those who have recovered from covid and were on immunosuppressive medications including steroids and on humidified oxygen, said Dr Rohit Udaya Prasad (Consultant, ENT and Hearing Implantology, Aster RV Hospital). Rhino cerebral Mucormycosis is an angioinvasive fungal infection affecting patients with poor immunity . It can be fatal for the patient as it spreads rapidly. Rhino-cerebral mucormycosis involves the nose/eye/brain.
Dr Srivatsa Lokeshwaran (Consultant, Interventional Pulmonology, Aster CMI Hospital) added, "Yes, we have seen a rise in invasive fungal infections like mucormycosis which is associated with a high mortality rate and morbidity. It tends to involve the sinuses, the eye and the brain. Covid itself beats down immunity.
When combined with diabetes, in post-transplant patients, with malignancy as a co-morbidity and some medications may predispose people to such infections. Other fungal infections like aspergillus which affects the lungs are also being increasingly picked up. These infections can significantly alter the course of the illness in patients recovering from covid 19, if not picked up earlier.”
Dr Prasad said, “Patients come with symptoms of facial pain / bloody nasal discharge/headache / blurring of vision and restricted eye movements. Antifungal therapy and surgical debridement is done as a treatment protocol. Survival depends on the presentation of symptoms. The spread of the fungus towards the brain via the eyeball has poor outcomes and prolonged hospitalisation. Due to the renal toxicity of the antifungal medications, patients may even need dialysis during treatment as the medications are given for a long duration.”
Dr Basavaraj Kuntoji (Consultant - Internal Medicine, Manipal Hospital , Malleswaram, Bengaluru) said, “In a pandemic situation like this, for moderate and severe covid patients, one of the only proven and evidence-based treatments available is steroids. With steroids, we have seen a very good recovery rate along with anticoagulants and other support treatments.
Hence we cannot deny the benefit while we are also worried about the side effects - which we all know for ages. Steroids are beneficial even in mild cases for symptomatic relief when we use it beyond five to seven days of onset of symptoms. However, if steroids are used beyond 10 days or without good control of blood sugar, they can lead to bactsupportivend fungal infections and also can lead to diabetic ketoacidosis.”
Dr Prasad suggested that patients need to see a doctor early for better outcomes in terms of survival. For humidified oxygen, it’s advisable to use distilled sterile water and it should be changed every 4 hours. The usage of steroids in the treatment of covid should be done under the supervision of the doctors and not self-medicated especially in diabetics, organ transplant recipients.