Amphotericin B & Mucormycosis
Context:
Minister of State for Chemicals and Fertilizers Shri Mansukh Mandaviya today reviewed the requirement and supply position of Amphotericin-B which cures Mucormycosis. The Government has chalked out a strategy with manufacturers to ramp up domestic production as well as to import the drug from all over the world.
About Amphotericin B
- Amphotericin B is an antifungal medication used for serious fungal infections and leishmaniasis.
- The fungal infections it is used to treat include aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, and cryptococcosis.
- For certain infections it is given with flucytosine.
- It is typically given by injection into a vein.
- Common side effects include a reaction with fever, chills, and headaches soon after the medication is given, as well as kidney problems. Allergic symptoms including anaphylaxis may occur. Other serious side effects include low blood potassium and inflammation of the heart.It appears to be relatively safe in pregnancy.There is a lipid formulation that has a lower risk of side effects. It is in the polyene class of medications and works in part by interfering with the cell membrane of the fungus.
What is Mucormycosis
Mucormycosis is a rare but serious infection that is caused by a group of moulds called mucormycetes. Colloquially termed ‘Black Fungus’, it was previously known as zygomycosis.
- Mucormycosis largely affects people who have health problems or use medicines that depress the body’s ability to combat germs and illness. It reduces the ability to fight environmental pathogens.
- It most commonly afflicts the sinuses or the lungs after inhaling fungal spores from the air. It can also happen on the skin after a burn, cut or other type of skin wound through which the fungus enters the skin. It can also affect the brain.
- People having co-morbities, variconazole therapy, uncontrolled diabetes mellitus, immunosuppression by steroids or prolonged ICU stay can get predisposed to the fungal infection.
- Warning signs include headache, fever, coughing, blood vomits, breathlessness and altered mental status
Types of Mucormycosis:
- Rhinocerebral (Sinus and Brain) Mucormycosis: It is an infection in the sinuses that can spread to the brain. It is the most common in people with uncontrolled diabetes and in people who have had a kidney transplant.
- Pulmonary (Lung) Mucormycosis: It is the most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant.
- Gastrointestinal Mucormycosis: It is more common among young children than adults, especially premature and low birth weight infants less than 1 month of age, who have had antibiotics, surgery, or medications that lower the body’s ability to fight germs and sickness.
- Cutaneous (Skin) Mucormycosis: It occurs after the fungi enter the body through a break in the skin (for example, after surgery, a burn, or other types of skin trauma). It is most common among people who do not have weakened immune systems.
- Disseminated Mucormycosis: It occurs when the infection spreads through the bloodstream to affect another part of the body. The infection most commonly affects the brain, but also can affect other organs such as the spleen, heart, and skin.
Symptoms:
- General symptoms are one-sided facial swelling and numbness, headache, nasal or sinus congestion, black lesions on nasal bridge or upper inside of the mouth, fever, abdominal pain, nausea and gastrointestinal bleeding.
- Disseminated mucormycosis typically occurs in people who are already sick from other medical conditions, so it can be difficult to know which symptoms are related to mucormycosis. Patients with disseminated infection in the brain can develop mental status changes or coma.
Mucormycosis Treatment
Mucormycosis is treated with prescription antifungal medicines, generally amphotericin B, posaconazole, or isavuconazole.
- To maintain sufficient systemic hydration, normal saline (IV) has to be infused before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks.
- Doctors advise to control diabetes, reduce steroid use, and discontinue immunomodulating drugs.
- Eventually, surgery may be required to remove the infected part. This can cause difficulties for patients who would need to come to terms with loss of function due to a missing jaw or an eye.
- For recovered coronavirus patients, it is important to monitor blood glucose level and control hyperglycemia. The use of steroids should also be prudent.
Prevention
Even though mucormycosis is a rare disease, certain groups are more vulnerable to it. What predisposes patients is uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, and comorbidities — post transplant/malignancy, voriconazole therapy. Doctors advise people to use masks if in the vicinity of dusty construction sites, wear long-sleeved shirts, shoes, long trousers and gloves while while handling manure, soil or moss. It is of utmost importance to maintain high standards of personal hygiene.
Government advisory
| Do’s | Don’ts |
| Control hyperglycemiaMonitor blood glucose level post COVID 19 discharge & in diabeticsUse steroid judiciouslyUse clean, sterile water for humidifiers during oxygen therapyUse antibiotics/ anti-fungal judiciously | Do not miss warning signs & symptomsDon’t consider all cases of blocked nose as of bacterial sinusitis, especially in the case of immunosuppression and/ or COVID 19 patient on immunomodulatorsdon’t hesitate in seeking aggressive investigations as appropriate for detecting fungal etiology don’t lose crucial time to initiate treatment for mucormycosis |
Why is Mucormycosis affecting COVID-19 patients?
Patients who have high levels of diabetes are at a higher risk of contracting covid-19. When this occurs, they are treated with steroids which compromises their immunity. According to doctors, steroids can prove to be a trigger for mucormycosis. While steroids help in reducing inflammation in lungs they can decrease immunity and increase blood sugar levels in both diabetics and non-diabetic covid-19 patients alike.
The black fungus disease is an additional burden on the country that is already grappling with more cases and fatalities due to the second wave of the covid-19 pandemic.
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