Most big hospitals in the region said they’re treating at least one case of an invasive fungal infection called mucormycosis or aspergillosis every day. There are about 60 big hospitals in the Pune Metropolitan Region (PMR).
Experts said rational use of steroids in diabetic patients, use of nasal anti-germ solutions such as betadine and sensitizing those who’ve recovered from Covid about post-infection red flags can avoid long-drawn, mutilating and expensive treatments.
“A steroid is certainly a life-saving drug in Covid-19. But it’s a double-edged sword. Steroids can increase blood glucose levels. These levels need to be tightly controlled to help Covid recovery and avoid secondary bacterial and fungal infections,” said infectious diseases expert Parikshit Prayag, from the Deenanath Mangeshkar Hospital (DMH) — one of the biggest Covid hospitals in Pune.
The hospital has had more than 75 cases of mucormycosis and over 100 cases of aspergillosis (mainly referred by other hospitals) since the start of the pandemic last March. Both are invasive fungal infections. Experts said the rise in these fungal infections now warrants a rethink of the one-size-fits-all blanket protocol for steroid administration in Covid patients.
“A stable Covid patient without hypoxia (blood oxygen dipping below 92%) should not be put on steroids. Also, it should be the lowest dose for the shortest possible duration; there is no role for high-dose steroids. When oxygen levels are normal, steroids can do more harm than good,” Prayag said. Sujata Rege, infectious disease specialist at Bharati Hospital, said, “Mucor organisms have an enzyme (ketone reductase) which allows them to thrive in high blood glucose and acidic conditions.”
Also, the role of oral and maxillofacial and dental surgeon is very important in the diagnosis of mucormycosis among patients. Maxillofacial surgeon JB Garde said mucormycosis usually sets in when discharged Covid patients are home isolated for a few more days. These recovered patients initially start to experience some stuffiness or nose blockage.