Maharashtra: Screening for black fungus if on oxygen therapy for over 7 days

PUNE: The state government’s latest guidelines have advised screening of a sizable chunk of hospitalized Covid-19 patients for mucormycosis immediately prior to or after the discharge.
This includes patients who have had steroid, oxygen therapy and intensive care unit (ICU) stay for more than seven days in hospitals.

Admitted patients with high blood sugar (above 200 mg/dL or glycated haemoglobin (HbA1C) above 8) would also be screened for the invasive fungal infection that primarily affects the sinuses. Patients who were given the anti-rheumatic drug tocilizumab must also be screened.
“The objective is to detect the disease early and treat it before it spreads to vital body parts. Treating hospitals should ensure that they are screening such Covid patients without fail,” public health expert Subhash Salunke, advisor to state government on Covid-19, said.
The state’s commissioner of health services and mission director, National Health Mission (NHM), issued the guidelines on May 17.
“The criteria for examination on discharge by an ENT specialist and, if required, by an ophthalmologist, include any of these factors the Covid patient had during the hospital stay,” the guidelines stated.
“Whether diabetic or not, increased blood sugar is the single most important factor in the development of this disease and so, sugar control is of foremost importance. Early screening to rule out mucormycosis among those who had uncontrolled sugar levels during the hospital stay is prudent,” said ENT surgeon Rajeev Yande.
Tocilizumab being an immunomodulatory drug and steroids being immunosuppressant drugs too are risk factors. “Hence, early screening is advisable (for those given these drugs),” said internal medicine expert Vichar Nigam.
Endocrinologist and Maharashtra task force member Shashank Joshi said seven parameters must be monitored during Covid patients’ in-home care.
“A close watch on sugar levels is needed during and after Covid treatment. Efforts must be made to keep the blood glucose level between 140-180. The post-Covid period is of three months,” Joshi said.
Maharashtra has recorded 1,500 cases of mucormycosis and 90 casualties so far this year. Almost 80% of the cases were detected between April 10 and May 20.
The state government in a GR on May 18, has allowed free treatment of mucormycosis under its health scheme, irrespective of the patient’s financial condition.