When the second wave of COVID-19 hit the country earlier this year, many among the survivors reported mucormycosis, an invasive fungal sinusitis that threatened to cost life or an eye in a patient. But a prompt and multi-disciplinary management of such patients at the Government Rajaji Hospital, Madurai, has helped to treat successfully all the 365 patients admitted between May and now.
The GRH is one of the six nodal centres for screening mucormycosis in the State and a tertiary centre for the southern districts. After the Tamil Nadu Government declared the Black Fungus a notifiable disease under Epidemic Diseases Act 1897 on May 20, a 60-bed mucormycosis ward was set up at GRH on May 25.
To take on the challenge of dealing with an increasing number of cases, Dean A. Rathinavel formed a multi-department team with the Heads of general medicine, ENT, ophthalmology, anaesthesia, microbiology, pathalogy and diabetology.
It helped in speeding up the treatment procedure and effectively managing the patients. While 331 patients have been discharged, 34 are under treatment.
Addressing a joint press conference with the HoDs, Dr. Rathinavel it was the timely intervention, early diagnosis and treatment and well-coordinated team work that prevented loss of life and eliminated the possibility of loss of vision in the patients.
Even as Tamil Nadu ranks fourth highest in the number of black fungus cases, GRH’s efforts stand out. An 80-year-old woman who was treated for COVID at a private hospital in Dindigul and reported with Karumpunjai three weeks later to GRH, on Saturday thanked the doctors for saving her life.
Professor of Medicine M. Natarajan said a majority of the patients had diabetes and the steroid usage during COVID treatment could have resulted in the fungal infection. It was challenging for the doctors as they could not afford to lose time between clearing the gangrene and controlling the sugar levels before starting the anti-fungal drug therapy to stem the spread of infection.
The tissue culture report takes five days but the doctors did not delay the treatment for patients who reported with symptoms in the eye or their nasal and brain CT showed presence of the black fungus. The quick approach yielded positive results, said diabetologist E. Subbiah.
He advised all COVID affected patients to use only disposable surgical or N-95 masks for at least a month after recovery, to avoid infection.
When the anti-fungal Amphoteritin-B injection was hard to get, the State Health Minister and the Health Secretary coordinated to ensure availability of adequate stock at GRH, the Dean said. While 262 patients underwent endoscopic suction clearance, 112 patients were treated for retro-orbital (eye involvement) and 12 for extension of mucormycosis in the brain.