New Delhi: The Centre has asked states to give top priority to “young patients” in treatment of mucormycosis or black fungus, a disease with high mortality rate. News18 has the copy of an advisory sent last week by the ‘National Task Force on Covid-19’, specifying the same.
This follows the Delhi High Court asking the Centre on June 1 to prioritise the young population over the older lot for giving Amphotericin B (AMB) drug whose shortage is being witnessed. The HC said the country needs to protect its future, the youth, while the elderly have lived their life and everyone cannot be catered to as AMB was available at only a third of the requirement.
The advisory sent on June 3 by the National Task Force on Covid-19 says that after young patients, the second priority for administering AMB be given to patients in whom surgical debridement is not possible or incomplete. Surgical debridement involves removing dead tissue or damaged skin, a step that could help saving an eye or stop escalating the disease that can cause death.
The management of mucormycosis should start with surgical debridement, the advisory says. It terms mucormycosis an issue of public health concern.
Nearly 29,000 cases of black fungus have been reported in the country so far, most of them being in post-Covid patients. The advisory said there are two types of Amphotericin B (AMB) drug – Liposomal Amphotericin and Doexycholate Amphotericin, which have equal efficacy but the latter is more toxic for kidneys of the patient if not given by slow infusion through a saline.
The advisory also says that Liposomal Amphotericin be used in cases of mucormycosis affecting the brain or in those patients who have a high sensitivity to Doexycholate Amphotericin. The document also makes it clear the Covid-19 associated mucormycosis (CAM) is not found to be predisposed following use of oxygen humidifier, oxygen concentrator or industrial oxygen.
“Use of clean masks in home environment at least one month beyond Covid hospital discharge, appropriate does and duration of steroids usage and proper sugar control in patients with Covid-19 can reduce incidence of CAM.
It also says patients with Covid-19 should be made aware of early warning symptoms of CAM as early diagnosis and appropriate management by multi-disciplinary team of physicians can improve the outcomes. “The post Covid-19 health checkup may require consultation with an ophthalmologist, ENT specialist, neurosurgeon and a dentist,” the detailed advisory has mentioned.
The advisory further specifies ‘do not’s – like not escalating the dose with AMB but rather start treatment with full dose, not using combination of antifungal therapy and not use voriconazole, echinocandins and 5 flurocytosine as they are not effective in Covid-19 associated Mucormycosis.
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