+Fungal

Importance

It might also help more rapid detection
because these mycosis are super-destructive.
Hence, it is important the molecular biologists develop & standardize the primers for detecting these.

Epidemiology

Comorbidities

  • Immune suppression (eg. with steroids)
Diabetes
  • majority of cases arise in patients with diabetes with high ketone concentration in blood.

Symptoms

  • Facial pain.
    • pain in eye, protrusion of orbit, loss of vision.
  • Nasal blockage / brown discharge
  • Headache.
  • Black lesions on upper inside of mouth.

Tests

  • Easy to confirm in case of facial variety - 1 hour result.

while it might not immediately affect treatment it would be good for them to keep an eye on: 1) what are the prevalent species in this wave? 2) Are ascomycetes also involved like aspergillosis? - MT

Treatment

  • Early detection and treatment essential. Else disease spreads to eye, then to brain or lungs.
  • Reduce immune suppressents (eg steroids), control glucose level.
  • Quick surgery to remove fungal material/ growth (else drugs won’t work) - even if it means removing the eye.
  • Ambisome( Amphotericin ). 3-6 weeks. The cost of one vial of Ambisome( Amphotericin ) used to be INR 4000. Use full dose.
  • A few months follow-up with other drugs.

Cost during COVID

  • But during COVID time 202105, as the demand has gone up,the cost of a 50mg vial has been increased to INR 7400.
    • An average 70Kg person requires 7 vials per day.It makes INR 50,000 per day.
  • A minimum of 10 days have to be administered. So the cost of the drug itself turns out to be INR 5 lakhs.
  • Plus the continuation phase requires oral antifungal drugs which are again expensive.

Detection

Is there a difference in pathology between the different species? This might be important for prevention especially if some species tend to be more common 1 could keep an eye on the common sources of decaying matter where they are growing in the vicinity of healthcare settings.

The most widely reported mucors include: Mucor, Rhizopus, Lichtheimia Cunninghamella, Rhizomucor, Apophysomyces & Phycomyces. Primers for these could be easily developed. In addition to the ascomycosis by Aspergillus, physicians would also want to keep an eye to see if Basidiobolus or Conidiobolus might be active. Further, their response to different antifungals should also be carefully monitored. Wonder if small molecules or odor tests could also allow a detection like Basidiobolus having that geosmin smell. But if it has come to that it might be too advanced.