PUNE: From 42 new cases the week before to just 16 last week (July 15-July 21), the detection rate of mucormycosis among Covid-recovered patients has seen a sharp drop across the Pune Metropolitan Region (PMR).
The 16 new cases takes the total number of Covid-associated mucormycosis (CAM) cases to 1,271 over the last three-and-a-half months. Experts said cases have been steadily dropping since the start of July.
"The fall in fresh cases of post-Covid mucormycosis is certainly heartening. Ample stock of key drugs such as amphotericin B is also helping patients recover faster," said district health officer Bhagwan Pawar.
In May, PMR had recorded 421 CAM cases. In June, it had 426. In July so far, only 69 people have been diagnosed with the invasive fungal infection, which mainly affects the sinuses.
Of the total 1,271 patients, 789 have recovered. Currently, 299 patients are undergoing treatment at various hospitals in the PMR.
Although fresh cases have gone down drastically, disease recurrence is an emerging concern. "Patients needing revision surgeries are coming up in sizeable numbers as quite a few of them (20%) are confronting disease recurrence days or months after recovery," said Sassoon hospital's ENT surgeon Samir Joshi.
What is more worrisome is the fact that a substantial number of these patients need repeat surgical clearance (debridement) even in areas like frontal sinuses, where recurrences should not happen. This indicates incomplete clearance of the damaged tissue during the first surgery, experts said.
The use of drug therapy, including amphotericin B injections, is also key to preventing recurrence. "To prevent a recurrence, disease control has to be properly achieved before changing amphotericin B to step-down therapy with oral posaconazole. Apart from incomplete debridement, breakthrough mucor can occur if optimal drug levels in the blood are not achieved," said infectious diseases expert Sanjay Pujari, a member of the national Covid task force.
Posaconazole levels should be achieved in the blood and should be measured three to five days after initiating treatment, Pujari advised.
A total of 172 of 1,271 patients have succumbed to CAM-associated complications in the district so far, accounting for a 14% mortality rate.
