Mucormycosis

Mucormycosis is a serious but rare fungal infection, caused by the ‘Mucormycetes’ group of fungi. It has been incorrectly called  ‘Black Fungus’ recently, but the fungi causing Mucormycosis are of a variety of colors.

It was prevalent as a secondary and opportunistic fungal infection which got amplified due to the surge in COVID cases. 

Key facts

• Mucormycosis (previously called zygomycosis) is a rare but serious angio-invasive infection caused by a group of fungi called mucormycetes. 
• Spores of these ubiquitous fungi (commonly found in soil, fallen leaves, compost, animal dung and air) can be inhaled and then infect the lungs, sinuses, and extend into the brain and eyes. Less often, infection may develop when the spores enter the body through a cut or an open wound. 
• Mucormycosis is not a contagious disease, it cannot be spread from one person to another.  
• Mucormycosis mainly affects people who are immunocompromised, or patients already infected with other diseases. High risk groups include people with diabetes (especially diabetic ketoacidosis), solid organ transplantation, neutropenia (low neutrophils, a type of white blood cells), long-term systemic corticosteroid use, and iron overload (hemochromatosis). The risk is high for people living with HIV, and those using immunomodulating drugs, including the anti-fungal voriconazole in some high-risk groups. 
• Clinical presentation is classified according to the organ involvement. It can be rhino-orbital cerebral, pulmonary, cutaneous, gastrointestinal, or disseminated. 
• Mucormycosis is an aggressive, life-threatening infection requiring prompt diagnosis and early treatment. Treatment usually consists of antifungal medications and surgery. 

Source : WHO

Precautions to be taken in hospitals 

The following activities/practices are to be undertaken to ensure that there are robust infection prevention and control practices in hospitals and other healthcare facilities:

• Establish/activate the Hospital Infection Control Committee with the head of the institution or an administrator as the chairperson.
• Designate an infection prevention and control nodal officer – preferably a microbiologist or senior infection control nurse.
• Prepare and implement the Infection Prevention Control (IPC) Programme in the hospital/health facilities, as per the guidance given in National Guidelines for Infection and Control in Healthcare Facilities. This involves the following key components of:
  • Infection prevention and control manual
  • Guidelines on antimicrobial use and management
  • Educational programmes and strategies
  • Risk assessment and risk management
  • Planning, monitoring, audit and feedback
  • Implementation strategies
• Emphasise and strengthen procedures and practices for IPC. 
  
  • Standard precautions are to be applied all across the hospital/health facility
  • Transmission-based precautions need heightened focus on droplet, airborne and contact precautions from the perspective of protecting healthcare workers and ensuring patient safety.
• Improve the environment and facilitate:
  • Ventilation with focus on fresh air and natural ventilation wherever control systems with requisite air changes are not available.
  • Cleaning, disinfection and sanitation of the hospital environment and frequently touched surfaces, with recommended disinfectants like 1% sodium hypochlorite or 70% alcohol.
  • Safe water and food to prevent water or food borne diseases in hospital settings
  • Biomedical waste needs to be managed as per the CPCB guidelines
• Infection Prevention and Control practices needs to be enhanced in Intensive Care Units (ICUs) using a bundle-approach to prevent device associated infections such as ventilator associated pneumonia or catheter-associated blood stream, urinary infections etc.
• Infection Prevention and control practise in the clinical laboratories and those attached to hospitals are very crucial for the safety of laboratory/hospital staff and health security of the community.
• Meticulous adherence to Infection Prevention and Control while managing immunocompromised patients such as patients on steroid treatment, with co-morbidities (such as diabetes where good glycemic control needs to be established; .
• In due course, establish surveillance of healthcare associated infections with focus on ventilator associated pneumonia, catheter-associated blood stream infection, catheter-associated urinary tract infection, surgical site infections, gastro-intestinal outbreaks. Further guidance can be taken from AIIMS HAI network; 
• Train all hospital staff to develop their skills in IPC, irrespective of their individual routine duties, in implementing procedures and protocols described in the Hospital Infection Control Manual.
• A State Nodal Officer needs to be identified to monitor the implementation of infection prevention and control to provide evaluation and feedback of the IPC programme in the state.

States and UTs have been assured that Ministry of Health and Family Welfare will provide all necessary assistance to implement the National Guidelines for Infection Prevention and Control in Healthcare Facilities.

Source : PIB