BLACK FUNGUS AND STEROIDS
Steroids as a class of drug has been indicted in the causation of mucormycosis in patients of COVID.
I would like to clarify and stress the fact that steroids have a proven role in covid and have played a vital role in saving millions of lives in this pandemic.
I agree the incidence of mucormycosis in covid patients have baffled a lot of doctors too.
We do know that lot of diabetic patients when given steroids in high doses, are prone to develop fungal infections. However, we have used steroids in many different conditions and in much higher doses in many patients before and have never seen such high incidence of mucormycosis.
I have personally used steroids in very high doses(in fact five to ten times more dose) in patients with optic nerve injury, spinal cord injuries, multiple sclerosis or in patients with CIDP (chronic inflammatory demyelinating neuropathy).
It is likely that there are contributing factors which has led to high incidence of mucormycosis in covid patients. These factors could be-
- The first factor could be the virus itself. The virus is inhabiting nasal mucosa and pharynx to begin with. During disease patients complain of dry nasal mucosa. The virus may be predisposing sinuses and mucosa to further fungal infection.
- Poor hygiene which is responsible for increased incidence of mucor. The equipments like oxygen concentrators, BiPAPs if not properly sanitised, unclean oxygen moisturing water, masks used for long periods without cleaning may be contributing in developing fungal infection.
- Healthcare workers are overstretched which has led to lesser focus on sugar control, infection control measures and patient hygiene.
- Overuse of antibiotics by the patient himself and doctors which predisposes to fungal infection.
I would insist that steroids definitely has a contributing role in mucormycosis but are not the only factor. We should continue to use them judiciously in covid infection.
I think good hygiene, optimal care and cleanliness of masks and disposables, rational use of antibiotics, optimal control of blood sugar and early diagnosis of infection should reduce incidence of mucormycosis.