No oxygen usage in 86 per cent mucormycosis cases: PGI study

Tribune News Service

Naina Mishra

Chandigarh, March 26

The doctors at the PGI have found that 86 per cent patients afflicted with mucormycosis had no history of oxygen use while 76.5 per cent had no history of steroid usage.

This is contrary to the explanation given by experts during the second wave of the pandemic that aberrant steroid use fuelled increase in fungal infection among patients.

ExpertSpeak

Dr Arunaloke Chakraborty, microbiologist from PGI, who headed the research, said: “In the selected group of patients we studied, steroids use was not found in a majority of them. We have raised the question whether Covid is responsible for mucormycosis or not. We are not overruling the steroid theory as it cannot be negated. We are assessing whether environment played any role, or was it the treatment that caused mucormycosis or Covid itself in a series of undergoing studies. We are in process of conducting a genetic study to ascertain whether Indians are more susceptible to this fungal infection or not.”

Patients categorised into three groups

• Patients diagnosed with Rhino-orbital mucormycosis were categorised into groups for the study in three stages – Pre-pandemic (May 2019-April 2020), Pandemic pre-epidemic (May 2020-April 2021) and Epidemic (May 1, 2021- July 12, 2021)
• The term “epidemic” has been used with respect to mucormycosis here
• The epidemic period witnessed more number of cases (370 cases), compared to 65 during the pandemic period and 42 in the pre-pandemic period

According to researchers, the process of “Covid itself may has been triggering fungal infection and the initial hypotheses, which put the primary responsibility for causing the outbreak on the management of Covid, might have been misplaced”.

The research titled “As the virus sowed, the fungus reaped! A Comparative Analysis of the Clinicoepidemiological Characteristics of Rhino-orbital mucormycosis before and during Covid Pandemic” was published recently.

The sudden surge of mucormycosis cases during the second wave of Covid was a significant public health problem in India.

Patients diagnosed with Rhino-orbital mucormycosis were categorised into groups for the study in three stages – Pre-pandemic (May 2019-April 2020), Pandemic pre-epidemic (May 2020-April 2021) and Epidemic (May 1, 2021- July 12, 2021).

The term “epidemic” has been used with respect to mucormycosis here.

The epidemic period witnessed more number of cases (370 cases), compared to 65 during the pandemic period and 42 in the pre-pandemic period.

However, the proportion of patients suffering from vision loss, restricted extra-ocular movement, palatal ulcer and nasal obstruction was higher in the pre-epidemic time.

The results also pointed out that 80.8 per cent had no history of hospitalisation prior to being infected with mucorales. This figure also rules the hygiene of oxygen supply/instruments/ interventions at the hospitals triggering the epidemic.

“The facts that mucormycosis cases continued to come unabated in spite of this reduction in steroid usage, and that steroid has been a mainstay of management in organ transplant recipients, auto-immune disorders, nerve palsies and airway stenoses for a long time with no evidence of any increased incidences of mucormycosis over the years, suggest that maybe we need to look beyond steroids as the main cause of concern,” reads the research paper.

The epidemic period, in spite of overwhelming the hospital services with the sheer volume of the patients and lack of medications, had the least mortality at 10 per cent, as opposed to 30.8 per cent people losing their fight against the fungus in the period before that.

The mortality and morbidity which showed an increase during the first wave of Covid decreased significantly during the second wave.

Researchers have also ruled out the possibility of patients developing mucormycosis after Covid as in maximum patients, it was a co-existing at the time of Covid.

Majority 313 (84.6 per cent) were Covid positive. They either became positive on testing at admission or detected positive within a week after admission to PGIMER.

The post-Covid mucormycosis cases were only 6.2 per cent, thus pointing towards an overwhelming evidence that Covid infection, especially in the second wave, is strongly associated with the spike in mucormycosis cases.

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