Covid-diabetes link leading to black fungus, feel experts

Naina Mishra

Tribune News Service

Chandigarh, June 13

City hospitals have witnessed 370 cases of mucormycosis so far with a majority of these patients being uncontrolled diabetic and having received steroids in inappropriate quantities during the Covid treatment.

“At least 87 per cent of the mucormycosis patients admitted to the PGI are diabetic. This is the most contributing factor for this fungal infection. At the same time, there is a fairly good number of patients who came with mucormycosis, but were Covid positive in the RT-PCR test. They were asymptomatic for Covid-19,” said Dr Naresh Panda, Head of the ENT Department, PGI.

There is now growing evidence that Covid-19 itself is triggering hyperglycaemia in patients. Dr GD Puri from the PGI said symptomatic patients even without history of diabetes had shown precipitation of diabetes at the PGI, Chandigarh.

Docspeak

Covid-19 directly affects the beta cells of pancreas, due to which the sugar level of the patient skyrockets. Coronavirus directly damages beta cells, which causes hyperglycaemia. In addition to this, cytokines storm caused by Covid-19 and steroid used for treatment also contribute to the increased sugar level. —Dr Sanjay Badada, Department of Endocrinology, PGI

Dr Sanjay Badada from the Department of Endocrinology, PGI, said: “Covid-19 directly affects the beta cells of pancreas, due to which sugar level of the patient skyrockets. Coronavirus directly damages beta cells, which causes hyperglycaemia. In addition to this, cytokines storm caused by Covid-19 and steroid used for treatment also contribute to increased sugar level”.

He said uncontrolled diabetes triggers acidosis (too much acid in body fluids) and fungus likes to grow in this environment.

In the latest study spearheaded by PGI doctors on mucormycosis, published in the CDC, US, revealed that inappropriate glucocorticoid use was associated with late Covid-associated mucormycosis. Appropriate steroid use was defined as dexamethasone-equivalent doses of six mg/day used for over 10 days. Any excess in dose or duration was classified as “inappropriate”.

Dr Panda said several patients had received steroids in excess quantities from outside. Their prescription cards were filled with high doses of steroids, which also triggered uncontrolled diabetic condition in these patients.

“None of the patients, who were discharged from the PGI, came with mucormycosis, because they were all managed well as far as steroids and sugar levels are concerned. All these patients either took steroids in home isolation or in other private facilities,” he said.

However, some doctors feel that the role of steam inhalation, unhygienic face masks and oxygen humidifiers cannot be undermined in the increasing number of mucormycosis cases in the second wave.

Dr Jagdish Chander, consultant microbiologist at the GMCH-32, said: “Overzealous use of steam inhalation for six-seven times a day and reusing the same mask for one to two weeks also increased the risk of acquiring mucormycosis. A high index of clinical suspicion for mucormycosis should be kept in those who have recovered from the viral infection.”

Dr Badada, in his recently published research paper, also highlighted the possible speculated causes of mucormycosis. According to the paper, reusable oxygen humidifiers may also play a major role in the transmission of potential nosocomial pathogens via the generation of aerosol particles, for they reach deep into the lung immediately after inhalation. Use of steam inhalation as well as non-humidified oxygen can lead to damage of the respiratory mucosa, allowing easy penetration of mucorales. Hence, it should be limited in post-Covid individuals, it stated.

‘Overzealous use of steam inhalation increased risk’

Dr Jagdish Chander, consultant microbiologist at the GMCH-32, said: “Overzealous use of steam inhalation for six-seven times a day and reusing the same mask for one to two weeks also increased the risk of acquiring mucormycosis. A high index of clinical suspicion for mucormycosis should be kept in those who have recovered from the viral infection.”