BENGALURU: While mucormycosis, the fungal infection prolonging the hospital stay of some patients who have recovered from Covid-19, is usually detected in the brain, nasal cavity and eyes, doctors are now finding it in the lungs of some patients.
Six such cases, called Covid-19-associated pulmonary mucormycosis (CAPM), have been diagnosed and treated in Manipal Hospitals, Old Airport Road, Bengaluru.
Dr Satyanarayana Mysore, HOD, pulmonology, Manipal Hospitals, says the challenge is to prepare patients for surgery, given that their lungs are already battered by Covid.
Surgery followed by antifungal treatment is the main treatment in CAPM.
“Bad lungs and a nasty fungus are a tough combination,” said Dr Mysore.
“The challenge is how to prepare a patient for surgery when the lungs are already in bad shape.
If the infection is seen in both lungs, surgery is not an option at all.
In two cases we conducted lobectomy or removal of a lobe in the lungs.” At Apollo Hospitals, Jayanagar, a team of pulmonologists comprising Dr Ravindra Mehta, Dr Sameer Bansal and Dr Hariprasad Kalpakkam and ICU specialists led by Dr Madhusudhan have launched a study on CAPM.
The team has treated five such cases so far.
Of the five, three suffered from high diabetes and one patient suffered from chronic kidney disease.
The youngest patient was a 43-year-old woman.
Four of the five patients in Apollo succumbed to the infection, while a 63-year-old male patient is recovering.
“The people who died were cases of very late referrals,” doctors said.
“They had received prolonged courses of steroids and had uncontrolled diabetes.” One such case of pulmonary mucormycosis was seen in Kalaburagi on June 22.
Pulmonologist Dr KS Satish, has treated three such cases, including one in September 2020.
“All three patients sur-vived.
Detection is tough and conducting procedures on these patients is very challenging.
We treated the three pa-tients without lobectomy,” he said, adding that in some cases, the patients also had infection in the sinus, which made the detection easier.
Typical symptoms of CAPM are cough, blood in the sputum and breathlessness because the lungs have already been infected earlier by Covid, Dr Satish said.
“In these cases, CT scans show cavities in the lungs.
Apart from exam-ination through bronchoscopy, there are definite radiological findings that suggest CAPM,” Dr Satish said.
Of the five patients seen in Apollo, the treating team diagnosed the presence of dual infection with both mucormyco-sis and another fungus aspergillus in three cases.
All of them also had drug-resistant bacterial infections.
According to Dr Mehta, CAPM can also present with dual fungal infections.
“This comes with enhanced challenges from all aspects, including diagnosis, treatment and prognosis.
Minimally in-vasive procedures such as bronchoscopy are needed to establish an early diagnosis,” said the team of Apollo doc-tors.
Dr Mysore said the need is to go beyond the causes of steroids and high diabetes leading to Mucormycosis infection.
“I feel that cell mediated immunity is the prime factor, which needs to be further researched,” he said.