Black fungus: Assam health dept restricts use of steroids

GUWAHATI: The Assam health department has restricted the use of steroids, broad spectrum antibiotics and prophylactic antifungal, particularly Voriconazole, to check the likelihood of the occurrence of more black fungus cases in the near future.
The state has reported two black fungus cases in the second wave of Covid-19 but health officials fear more such cases may surface due to the prolonged treatment of patients in ICUs.
“Injudicious use of steroids and broad spectrum antibiotics/prophylactic antifungal particularly Voriconazole must be avoided at all costs,” read the SOP sent to the health authorities.
The health department, in its latest SOP, has asked for regular cleaning and wet mopping of ICU, wards and hospital premises at least twice a day. Dedicated teams have to be constituted by hospitals to treat suspected black fungus cases, many of which are feared to be hidden and unreported.
The directive stated that a multi-specialty team, including specialists from Oro-Facial -maxillary, ENT, neurosurgery, ophthalmology and plastic surgery, should be ready for immediate surgery as debridement of infected tissue is the only confirmatory treatment.
“All high risk patients who had steroid treatment should be subjected to baseline neutrophil count, and then every third day until discharge,” it ordered. In case the count is less than normal, they should be screened for any fungal infections.
The preventive strategy is early identification of Covid and non-Covid patients at risk for mucormycosis that includes patients with uncontrolled diabetes mellitus (specially having diabetic ketoacidosis), neutropenic patients and those with history of frequent blood transfusion (may lead to increase free iron in blood).
It asked for thorough monitoring of the immunosuppressed patients, and those with long standing chronic issues, including kidney diseases and subsequent follow up must be ensured.
Mucormycetes is the group of fungi that cause mucormycosis or black fungus and it’s present throughout the environment. But the biggest concern is the unhygienic condition in some of the hospitals, which shocked health minister Keshab Mahanta during his recent trip to regions like the Barak Valley.
According to health experts, the possible source of mucormycetes in the hospital environment like damp wall and floor, AC filters, old food materials, any organic materials, soiled and contaminated linens, including bandages, masks, equipment and devices used for patient care, contaminated oxygen cylinder and its accessories, humidifiers and leakage in water pipes should be specifically checked frequently to avoid any occurrence of mucormycosis.
Considering the looming black fungus threat, the health department has ordered that no food materials should be kept inside the hospital premises for more than an hour. “The hospital environments should be free of all organic materials,” the SOP stated.
It has been made mandatory that humidifier bottles must be changed once a week for the same patient and in between patients. Health officials said that when a patient continues to get humidified oxygen that contains water vapour, it helps in the growth of fungus.
“Only sterile water is to be used in the humidifiers,” the SOP directed, asking for weekly cleaning of the cylinder, valver and flowmeter. Nasal canula is also to be changed in two to four weeks.