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Experts offer suggestions for curtailing emerging "black fungus" syndemic in India
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Experts suggest limited and careful use of corticosteroids as one of several strategies to curtail the syndemic of mucormycosis, or "black fungus," a fungal infection characterized by blackening or discoloration over the face, breathing difficulties, and other serious symptoms, that has recently emerged in India. A commentary from Washington University School of Medicine and the University of Massachusetts Medical School is published in Annals of Internal Medicine.

Having diabetes and other conditions that compromise the immune system puts patients at increased risk for mucormycois, as does receipt of immunosuppressive chemotherapy including corticosteroids. Mortality is high, especially if diagnosis and prompt initiation of medical and surgical therapy are delayed. Currently, India has more than 65 million adults with diabetes and is experiencing a second wave of COVID-19 with 28.2 million cases reported. In the midst of this crisis, a "syndemic" of rhino-orbito-cerebral mucormycosis infections has arisen, with nearly 9,000 cases reported.

The commentary authors recommend several strategies for preventing and managing this syndemic of mucormycosis. Nonpharmacological measures, such as masking policies and social distancing, should be taken to reduce risk for transmission of SARSCoV-2 and widespread vaccination should be implemented, as soon as possible. For those infected with SARS-CoV-2, preventing mucormycosis is crucial. This means avoiding exposure to the fungi that cause mucormycosis and limiting the use of corticosteroids and antibiotics, which have been overused in India, thus far. Glucocorticoids have no benefit in patients who do not require respiratory support, as they predispose them to mucormycosis and increase blood glucose levels in persons with prediabetes and diabetes, prevalent conditions in India. As such, the authors suggest that stronger restrictions on over-the-counter sales of systemic corticosteroids and antibiotics should also be considered. Those issued for hydroxychloroquine in March 2020 contributed to reduced hydroxychloroquine sales during the first wave of the pandemic.


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