Indian Medical Graduate - IMA, Dr.

Mucormycosis, a new cause for worry after the coronavirus disease (Covid-19) infection, has infected at least 7,250 people in India. Also known as black fungus, the infection is a Covid-19 complication which has killed at least 219 people in the country, according to the figures shared by officials in 13 states and Union territories with HT.

Black fungus: Here is a list of states with highest number of mucormycosis cases

On Thursday, the Central government said the states should declare the disease notifiable under the Epidemic Diseases Act, 1897.
Here is the list of states with highest number of black fungus:

Maharashtra: The state has 1,500 cases of mucormycosis and 90 deaths due it.
Gujarat: As many as 1,163 cases of mucormycosis have been detected and 61 people have died due to it.
Madhya Pradesh: The state has 575 cases of and 31 deaths due to mucormycosis.
Haryana: As many as 268 cases, eight deaths due to mucormycosis have been reported in Haryana.
Delhi: The national capital has registered 203 cases of mucormycosis and one death due to it.
Uttar Pradesh: The state has registered 169 cases of mucormycosis and eight deaths due to it.
Bihar: As many as 103 cases, 2 deaths due to mucormycosis have been registered in Bihar.
Chhattisgarh: Mucormycosis has been detected in 101 people and one person has died in the state because of it.
Karnataka: While 97 cases of mucormycosis have been reported in this southern state, the number of people who died due to it stand at zero, according to official data.
Telangana: As many as 90 cases of mucormycosis have been detected here and 10 deaths have also been recorded.

Post Covid Mucormycosis.....

During the current pandemic of COVID-19, a wide range of symptoms and complications have arisen and are being identified. Although rare, recently, mucormycosis, a serious fungal infection commonly known as mucormycosis and colloquially as “black fungus”, has been observed among people hospitalized or recovering from COVID-19, with some requiring urgent surgery. While there is no major outbreak, several mucormycosis cases have been detected in Delhi, Maharashtra, and Gujarat. Therefore, the national COVID-19 task force has issued an advisory on the disease under the Department of Health Research, Ministry of Health and Family Welfare, Government of India.

🛑 Mucormycosis is caused by a group of moulds recognized as mucormycetes present naturally in the environment.

🛑 As per the advisory, the disease often manifests in the skin and also affects the lungs and the brain, especially in those who are on medications for health problems that reduce their ability to fight environmental pathogens.

🛑 Sinuses or lungs of these individuals get affected after they inhale fungal spores from the air.

🛑 Uncontrolled diabetes mellitus, prolonged ICU stay, comorbidities (such as malignancy and post-transplant), therapies with Voriconazole, and immunosuppressant drugs, such as steroids, predispose patients to develop mucormycosis.

🛑 Warning signs of mucormycosis include pain and redness around the eyes or nose, fever, headache, coughing, shortness of breath, vomiting with blood, and altered mental status.

🛑 According to the advisory, infection with mucormycetes can be suspected if a COVID-19 patient (hospitalized or recovering), immunosuppressed individuals, or those with diabetes experience sinusitis, i.e. nasal blockade or congestion, nasal discharge (blackish/bloody); local pain on the cheekbone, one-sided facial pain, numbness or swelling; blackish discolouration over the bridge of nose/palate; toothache, loosening of teeth, jaw involvement; blurred or double vision with pain; thrombosis, necrosis (eschar), skin lesion; chest pain, pleural effusion, haemoptysis, and/or worsening of respiratory symptoms.

🛑 There are mostly two manifestations of mucormycosis in patients with post-COVID-19 complications, which are rhino-orbital-cerebral and pulmonary.

🛑 There is no biomarker to detect mucormycosis; therefore, other mould infections should be ruled out through negative galactomannan and beta-d-glucan tests.

🛑 Physicians should have a high index of suspicion for mucormycosis, as some Mucormycetes species (including C. bertholletiae and R. pusillus) can cause such infections.

🛑 Biopsy remains the mainstay of diagnosis.

Mucor is difficult to culture routinely, and the benefits of biopsy outweigh the risk, even in a ‘difficult to access’ location or in the presence of coagulopathy. However, pulmonary mucormycosis can be distinguished from Aspergillosis due to certain radiographic findings.

🛑 Other rapid diagnostic methods include KOH mount and Calcofluor stain.

🛑 Mainly, mucormycosis can be managed or prevented by reversal of underlying predisposing factors, such as by controlling hyperglycaemia and diabetic ketoacidosis in COVID-19 recovered patients and in those with diabetes; and using steroids and antibiotics/antifungal agents judiciously (when needed). Such patients can also be advised to discontinue immunomodulating agents and reduce steroids; no antifungal prophylaxis is needed for such patients.

🛑 Experts have advised using masks while visiting dusty construction sites; wearing shoes, long sleeve shirts and gloves, and long trousers while handling soil (gardening), moss, or manure; and maintaining personal hygiene, including a thorough scrub bath.

🛑 Medical treatment of mucormycosis mainly includes installing peripherally inserted central catheter (PICC line), maintaining adequate systemic hydration, infusion of normal intravenous saline before Amphotericin B infusion, and at least 4-6 weeks of antifungal therapy. Amphotericin B has been the standard treatment for invasive mucormycosis; however, acute or chronic renal failure may develop in patients with COVID-19. Therefore, in COVID-19 patients, a less- or non-nephrotoxic alternative of Amphotericin B, such as Posaconazole or Isavuconazole, can be suggested.

🛑 Adjuvant therapy with Caspofungin, Deferasirox, statins, Aspirin, and Hyperbaric oxygen may have to be considered as well.

🛑 The optimal timing of surgery to reduce the risk of transmission to the operating team and the operative risk to the patient with COVID-19 is a contentious issue.

🛑 Moreover, patients must be advised to regularly monitor their blood glucose level post-COVID-19 discharge and use clean, sterile water for humidifiers during oxygen therapy.

As India battles the second wave of Covid infections, an anti-Covid drug found to help speed up recovery and reduce oxygen dependence has been launched by the government.

The drug, named 2-deoxy-D-glucose (2-DG), has been developed jointly by Institute of Nuclear Medicine and Allied Sciences, a lab of the Defence Research and Development Organisation (DRDO), in collaboration with Dr Reddy's Laboratories, Hyderabad.

The Drugs Controller General of India (DCGI) earlier this month granted permission for emergency use of the drug as an adjunct therapy in moderate to severe Covid patients

As per the source the price will range from 500-600 INR.

INI-CET for admission to PG courses of INIs for July 2021 session has Postponed.
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Budget 2021: Rs 2.23 lakh cr announced for healthcare; Rs 35,000 cr for COVID vaccination

Finance Minister Nirmala Sitharaman on Monday announced a new Centre-sponsored scheme with an outlay of Rs 64,180 crore to boost healthcare infrastructure across the country amid ongoing COVID-19 pandemic. The total budget outlay for healthcare is 2.23 lakh crore. This is an increase of 137% from last year, says FM Sitharaman. FM announces Rs 35,000 crore for Covid-19 vaccines.

Video source➡️
https://youtu.be/oBuK0K8532c

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COVID-19 Vaccine Intelligence Network has been developed for planning, implementation, monitoring, & evaluation of COVID-19 vaccination in India, health minister Dr Harsh Vardhan said. Co-WIN will facilitate real time information of vaccine stocks, storage temperature during the COVID-19 vaccination drive, Prime Minister's Office said in a statement on Thursday. "There are five modules in Co-WIN app - administrator module, registration module, vaccination module, beneficiary acknowledgment module and report module," health secretary Rajesh Bhushan said earlier.

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➡️ According to the website, the secretary comes second in the hierarchical order. It has placed four autonomous boards under the secretary which contradicts the Act as the secretary has to assist the boards in secretarial functions and not supersede them.

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