What is CAM?- Cause, Prevention, and Treatment.

CAM is Covid associate mucormycosis. It is an angioinvasive fungal infection caused by filamentous fungi in the subphylum Mucormycotina. These fungi are also known as black fungus.

These fungi have very low virulence and which affects immunocompromised individuals,severely hyperglycemic patients, severe burns, and other debilitating diseases as well as dialysis with the iron chelator deferoxamine.

In immunocompetent patients, it may be encountered in patients with severe soft tissue trauma eg crush injury or military trauma.

Spores of the fungus mainly found in soil and air. The mucormycosis is acquired primarily via inhalation of environmental spores present in the air mainly in immunocompromised persons like transplant recipients or persons using steroids chronically for other conditions.

The leading pathogens among this group are species of the genera Rhizopus, Rhizomucor, Lichtheimia, Cunninghamella, Mucor, etc. The most prevalent agent is Rhizopus oryzae.

Clinical features

The major clinical form is rhinocerebral mucormycosis, which results from the germination of the spores in the nasal cavity and the invasion of the hyphae into the blood vessels. The disease can progress rapidly with the invasion of the sinuses, eyes, cranial bones, and brain. Blood vessels and nerves are damaged, and patients develop edema of the involved facial area.

In this clinical spectrum, patient have complaints of

  1. headache,

2.nasal blockage,

3. nasal secretions and bleeding,

4.pain and redness of the eye,

5. blurred or double vision,

6.loss of sensations over one side of the face,

7.facial edema,

8. black discolouration around the bridge of nose etc

Pulmonary mucormycosis follows the inhalation of the sporangiospores with the invasion of the lung tissue and blood vessels. In this scenario, patients have a fever, chest pain, and pneumonia-like features.

Why cases are rising in Covid?

Cases of mucormycosis is rising in Covid because

  1. Covid cases which have a prolonged duration of illness are in an immunocompromised state making them vulnerable to these fungi.
  2. Misuse of steroids to treat covid illness like the use of steroids for milder cases, steroid use for a longer duration, etc.
  3. Poor control of blood sugar in diabetic patients with Covid.
  4. Prolong ICU stay.
covid and mucormycosis

Preventions

For prevention of mucormycosis in Covid patients few important steps must be taken to prevent it.

  1. Strict control of blood sugar in diabetic patients affected with Covid.
  2. Avoid steroids in mild to moderate cases of Covid and if used reduce treatment duration.
  3. Wear masks because persons get mucormycosis by inhalation of spores.
  4. Use clean and sterile water for humidification of oxygen during oxygen therapy.
  5. Contact your doctors if any kind of symptoms develops in a covid patient especially diabetic patients.

Diagnosis

A high index of suspicion in immunocompromised patients is essential because most signs, symptoms, and radiographic signs are nonspecific.

Direct examination or culture of nasal discharge, tissue, or sputum will reveal broad hyphae (10–15 μm) with uneven thickness, irregular branching, and sparse septations.

Diagnosis is typically confirmed by histopathologic documentation of “ribbon-like” angioinvasive hyphae in tissue.

Treatment

Stop steroid and other immunosuppressive drugs.

Control blood sugar level.

Treatment consists of aggressive surgical debridement, rapid administration of amphotericin B, and control of the underlying disease. Lipid formulations of amphotericin B are the drug of choice.

disclaimer: information provided here is purely for the knowledge purpose and it should not be used as a substitute for medical advice.