Thread by @cspramesh

There has been a lot of panic in India about the “black fungus” which has caused substantial concern, morbidity and even deaths in patients with COVID. This is a short thread to explain what we know about it

The truth is that we don’t know everything about it, but let’s start by calling it what it is – “Mucor”. And anybody who claims that they know all about it is hmm…., let's say, “factually incorrect”

First, how does mucor spread & how do patients with #COVID-19 get infected with it? Mucor is a fungal infection caused by “mucormycetes”, a group of fungi. These fungi are ubiquitous – in soil, fallen leaves, compost, and air. Yet, most of us don’t develop the disease

How does someone get infected with mucor? Most commonly, it is inhaled through the nose. Wearing a mask therefore, probably helps prevent it.
Is mucor contagious? No – you can’t get infected by being in close contact with someone else who has the disease.

What makes you more prone to develop mucor? By far the most important reason is reduced immunity – and there are several reasons for this – diabetes, being on steroids, taking immunosuppressant drugs, chemotherapy, and so on.

Why are we seeing such an outbreak of mucor in India now? It’s actually a combination of reasons – the incidence of diabetes in India is quite high. Combine that with the widespread use of steroids in patients with #COVID_19, with poor glucose control – this is a bad combination

Are diabetes and steroid use the only reasons? We’ve also heard about possible industrial grade oxygen, tap water in humidifiers, reused masks, antibiotic overuse, all being possible reasons. Again, the truth is that we just don’t know.

While we have incomplete information about all the above, the most important causes remain uncontrolled blood sugar levels, and indiscriminate use of steroids.

It is extremely unlikely that the use of industrial grade oxygen is a cause – fungi cannot survive in that environment. Similarly, while tap water may be responsible for other fungal infections, there is no data currently to suggest that tap water in humidifiers causes mucor

Antibiotic overuse is rampant in India, even more in patients with #COVID_19, and I strongly advocate against its use. But just like reuse of masks, these were far more prevalent in the last wave, and we didn’t see as much mucor.

So, what can we do to reduce the chances of contracting mucor? First, if you have diabetes, make sure your blood sugar levels are controlled. Uncontrolled diabetes is one of the strongest risk factors for being infected with mucor

Second, please don’t use steroids unless prescribed by your doctor. Indiscriminate steroid use harms in two ways – first it reduces your immunity; second, it raises your blood sugar levels. Both of these predispose you to getting infected with mucor.

Does that mean that you should not give steroids in #COVID_19? No, just that you need to be careful about not using them when they are not required – which means that if your oxygen saturation levels are normal, steroids probably do more harm than good.

What happens if you have diabetes and develop severe #COVID_19 requiring steroids? The risk-benefit ratio is still in favour of giving steroids, but utmost care is needed to ensure that your blood sugars are controlled. And do not prolong the use of steroids

What are the symptoms of mucor? Usually, the symptoms include swelling of one side of your face, a feeling of stuffed nose, headache, red eyes, blackening of the bridge of your nose or your palate, discharge from the nose, and fever

What should you do if you develop these symptoms? First, please do not try to manage this at home, or self medicate. Mucor requires urgent hospitalization and treatment – please get admitted in a hospital.

Mucor can be treated and cured if detected early and treatment instituted. Medical management includes amphotericin B, posaconazole, or isavuconazole. Some patients may require surgery

Cliched as it may sound, mucor is better prevented than cured. Which brings us back to
1.Keep your blood sugar under control
2.Avoid unnecessary use of steroids

But seriously, there are much better options…

Do whatever you can to prevent infection with COVID_19. The 3 Ws – Wear a mask, Watch your distance, Wash your hands
And get vaccinated whenever you are eligible.
Take care, and stay safe, folks.