Discover and read the best of Twitter Threads about #mucormycosis

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Hey #medicine residents !!

Let's talk a bit about #mucormycosis today, the monster fungus 😡

Horrible infection w/ an unreasonably high mortality (40-80%) 😭

Risk factors:
🔸DM
🔸Neutropenia
🔸Post-HSCT

DM- Rhino-orbito-cerebral mucor
Neutropenia- Pulmonary mucor

#MedTwitter
The disease is caused by fungi of the order "MUCORALES"

This includes rhizopus/mucor/licthemia/cunninghemela species 😮

DON'T WORRY species identification doesn't change treatment so we don't need to get to that 🙏🏻

#MedTwitter
Coming to the PRACTICAL POINTS that need to be remembered !

🔸Obtain IMAGING even at the slightest suspicion of mucor coz it's RAPIDLY PROGRESSIVE and kills quick.

🔸CT PNS/Orbits
🔸MRI Brain
🔸HRCT chest as per presentation

#MedTwitter
Read 10 tweets
#idboardreview 50 M s/p renal transplant 50 days ago, present w/ fever, seizures, pneumonia, skin lesions. Biopsy with wide ribbon aseptate hyphae, typical fruiting head on SABDX, LPCB stain. dx? #meded #idmeded #idtwitter ImageImageImage
#Cunninghamella bertholletiae characteristic sporangiophores with swollen terminal vesicles and ovoid sporangioles
Read 8 tweets
Images of Infectious Diseases

46F with diabetes presents with orbital apex syndrome. Imaging and histopathology shown. What is your differential diagnosis? #MayoIDQ to follow @StephanieGrach @ZYetmar @omarabusaleh15 Image
2/ #MayoIDQ
46F with uncontrolled DM and recent DKA is admitted because of left sided HA for a month. PE: orbital apex syndrome. Head imaging shown. ENT/neurosurgery proceeded with debridement. Pathology shown. Which one of the following choices is most correct?
3/
Case diagnosis: Rhinocerebral #mucormycosis due to #Rhizopus in a person with poorly controlled diabetes mellitus

Rx:
Surgical debridement
Liposomal #Amphotericin B

Later: transitioned to #Posaconazole upon clinical control and improvement
Read 6 tweets
#BombayHighCourt to hear clutch of petitions on various issues pertaining to #COVID19 management in #Maharashtra and availability of drugs to treat #mucormycosis.

Hearing before CJ Dipankar Datta and Justice GS Kulkarni.

@CMOMaharashtra
@mybmc
AG Anil Kumbhakoni and ASG Anil Singh appears for State and Central governments respectively.

Advocates Arshil Shah, Rajesh Inamdar, Simil Purohit, Ajinkya Udane appear for the petitioners.

@ArshilAjay
@rajinamdar22
@ajinkyaudaneadv
Hearing begins.

Court: Mr AG and ASG, we have across in the last few days, particularly after the cyclone hit the coast, we have come across various newspaper reports which says that the coastline is full of filth and garbage left behind.

#BombayHighCourt
Read 10 tweets
#BombayHighCourt to hear clutch of petitions on various issues pertaining to #COVID19 management in #Maharashtra and availability of drugs to treat #mucormycosis.

Hearing before CJ Dipankar Datta and Justice GS Kulkarni.

@CMOMaharashtra
@mybmc
AG Anil Kumbhakoni and ASG Anil Singh appears for State and Central governments respectively.

Advocates Arshil Shah, Rajesh Inamdar, Simil Purohit, Ajinkya Udane appear for the petitioners.

@ArshilAjay
@rajinamdar22
@ajinkyaudaneadv
The Court will also hear application filed by #SonuSood seeking intervention on the ground that the orders being passed in the PILs may affect him and hence he is necessary party.

@SonuSood
Read 19 tweets
Bench led by Chief Justice Dipankar Datta of #BombayHighCourt is hearing the suo motu public interest litigation on COVID issues in Marathwada region at Aurangabad.

The Bench is hearing on the issue of #Mucormycosis

#COVID19
CJ Datta asks what is the patient population suffering from #Mucormycosis in Maharashtra and other states, what is the distribution of drugs. We cannot issue mandamus saying distribute so many drugs.

#BombayHighCourt
CJ Datta: But this exercise should have been done by you to show us equitable distribution.

Chief Public Prosecutor DR Kale submits the data which was submitted by the Advocate General before the Principal Bench.

#BombayHighCourt #Mucormycosis
Read 13 tweets
Alert🚨 Drop in #Mucormycosis cases in #Gujarat

For the first time since fungal infections ran rampant in Gujarat during the 2nd #Covid wave, there is a visible drop in the no. of patients in eight major govt hospitals of Guj.

June 2: 1,940
June 6: 1,982 🔼
June 10: 1,866🔽 Image
Caveat: While drop in the number of #Mucormycosis patients in major govt hospitals of #Gujarat is indeed good news, we must take into account that not all hospitals have seen this drop, a few have even seen cases rising. Still no data from pvt hospitals.

More tomorrow morning.
@MSG_ERC @AnantBhan @raghurajs_hegde @ProfSomashekhar @DMavalankar @naveenthacker @arunaloke2 @GermHunterMD @malini_aisola @joshirakesh2016 @SSGHOSPITALVAD looks like while cases drop in Gujarat, they may be rising in other states where the secondCovid spike started late.
Read 5 tweets
#BombayHighCourt to hear clutch of petitions pertaining to management of #COVID19 in #Maharashtra.

Hearing before Bench of Chief Justice Dipankar Datta and Justice GS Kulkarni.

@CMOMaharashtra
@mybmc Image
Adv General Ashutosh Kumbhakoni appears for State, ASG Anil Singh appears for Centre, Sr Adv Anil Sakhare appears for BMC.

Advocates Simil Purohit, Arshil Shah, Rajesh Inamdar, Ajinkya Udane appear for petitioners.

#BombayHighCourt

@ArshilAjay
@rajinamdar22
Hearing begins.

#BombayHighCourt
Read 22 tweets
स्वास्थ्य सेवा महानिदेशालय #DGHS @MoHFW_INDIA द्वारा #COVID19 रोगियों के प्रबंधन के लिए व्यापक दिशानिर्देश जारी किए गए हैं जिसमें लक्षणों की गंभीरता के आधार पर रोगियों का इलाज, जांच और निगरानी कैसे करें वर्णित है।

दिशानिर्देश: dghs.gov.in/WriteReadData/…
दिशानिर्देश स्पर्शोन्मुख, हल्के, मध्यम या गंभीर लक्षणों वाले रोगियों के लिए #COVID19 के संभावित लक्षणों को वर्गीकृत करता है।

स्पर्शोन्मुख और हल्के से बीमार के लिए- घर पर अलगाव की सिफारिश की गई है।

घर पर कोविड19 को प्रबंधित करने के उपायों के लिए:
हल्के लक्षणों वाले रोगियों के लिए दिशानिर्देश में बुखार, सांस फूलना, SpO2, BP या किसी भी लक्षण के बिगड़ने के लिए स्व-निगरानी के लिए स्व-देखभाल प्रदर्शन का विवरण दिया है।

यदि लक्षण बने रहते हैं या बिगड़ जाते हैं, तो चिकित्सा जांच की आवश्यकता हो सकती है।
Read 9 tweets
Comprehensive Guidelines for Management of #COVID19 patients has been released by Director-General for Health Services (#DGHS), @MoHFW_INDIA.

Depending upon the severity of symptoms, it guides how to treat, investigate & monitor patients.

Guideline: dghs.gov.in/WriteReadData/…
The guideline categorises the possible symptoms of #COVID19 for patients with Asymptomatic, Mild, Moderate or Severe symptoms.

For Asymptomatic & Mildly ill- Home isolation for care recommended.

For Home Care Tips to manage COVID19 by @PrinSciAdvOff:
For patients with Mild Symptoms, the guideline details a #selfcare performa for Self-monitoring for fever, breathlessness, SpO2, BP or worsening of any symptoms.

If symptoms persist or worsen, further medical investigations may be required.

#COVID19 #IndiaFightsCorona
Read 9 tweets
Aurangabad Bench of #BombayHighCourt is hearing suo motu public interest litigation on COVID issues in Marathwada region.

Bench of Justices RV Ghuge and BU Debadwar is hearing Centre’s response on the issue of #ventilators

#COVID19
Bench notes from an affidavit submitted by the Centre that the ventilators issue has been sorted.

Court: We do not want to order that use these ventilators. We leave it upon the doctors and the medical staff to take that call on using the ventilators.

#BombayHighCourt
Court: We have been told through this affidavit that the ventilators are safe to be used on patients. With proper back-up if they can be used then..
Back-up in the sense, if there is some fault, then the patient does not suffer.

#BombayHighCourt #COVID19
Read 40 tweets
Have questions on Covid19 recovery?
We answer the most important ones in this master thread. #stayaware

❓Is a #Covid test required to confirm recovery?

If you do not have any symptoms 14 days after confirmation of Covid, a repeat test IS NOT required.

1/n
❓When can I consider myself recovered from Covid?

➡️ 14 days after date of test.
➡️ 3 consecutive days of no symptoms.
➡️ If you had severe symptoms, consult your doctor for discharge criteria.
➡️ No need for a repeat RTPCR test.

2/n
❓Do I need to continue wearing masks inside my home after recovery?

No. One does not generally transmit the virus after Day 10 of infection. After 14 days of room quarantine, there is no need to wear a #mask inside the house.

3/n
Read 15 tweets
Our paper on co-infections, secondary infections & antimicrobial use in patients hospitalised with #COVID19 in UK during the 1st wave is out in @LancetMicrobe!

@ISARIC1 @CCPUKstudy @CVRinfo @UofGlasgow @EdinburghUni @LivUni @imperialcollege

thelancet.com/journals/lanmi…

A🧵
2/ Of 48,902 hospitalised Covid19 patients enrolled in CCP-UK study (6 Feb - 8 June 20):
- 8,649 (17.7%) had >=1 microbiological investigation
- 1,107 had Covid19-related bacterial infection (blood or respiratory); 70.6% (n=762) were secondary infection (>48 hrs from admission)
3/ Most frequently identified organisms:
- Respiratory co-infection: Staph aureus & Haemophilus influenzae (differ from flu)
- Respiratory 2ry infection: Gram negative organisms & Staph aureus (similar to non-Covid HAI)
- Bloodstream co-/2ry infections: E Coli & Staph aureus
Read 9 tweets
#BombayHighCourt is hearing Suo Motu plea concerning #COVID19 situation in districts falling within the Aurangabad Bench jurisdiction.

Bench of Justices RV Ghuge and BU Debadwar are dealing with the issue of #mucormycosis.
Court is informed that till today in Aurangabad there have been 49 deaths, and in Nanded 35 deaths.
In Marathwada region, 124 deaths have taken place till date.

#COVID19 #BombayHighCourt
Court: And what is the stock of the #AmphotericinB with us?
Because the affidavit in the Principal seat says about 5-6 vials are required in a day, and we were told yesterday that only 1-2 vials in a day. SO what is it? Undertreatment?

#COVID #BombayHighCourt
Read 47 tweets
#Murcormycosis - काळी बुरशी आणि महामारीच्या काळात दातांची स्वच्छता याविषयी ऐका तज्ज्ञांकडून

थोड्याच वेळात, 11.00 वाजता वेबिनार

पाहा-

#Unite2FightCorona
#Unite2FightCorona

#Murcormycosis - काळी बुरशी आणि महामारीच्या काळात दातांची स्वच्छता याविषयी ऐका तज्ज्ञांकडून

थेट प्रसारण-

वक्ते- @RajeevJayadevan
#Murcormycosis बुरशीजन्य संसर्ग आहे.

कोविड विषाणुमुळे प्रतिकारक शक्तीवर विपरीत परिणाम होतो.

मधुमेह रुग्ण ज्यांना कोविड संसर्ग झाला आहे आणि जे मोठ्या प्रमाणात स्टिरॉइडचा वापर करतात, त्यांना या संसर्गाची बाधा होण्याची मोठी शक्यता असते: डॉ राजीव जयदेवन

#Unite2FightCorona
Read 13 tweets
One of our most active initiatives right now is the free Medical Help group.

Few observations:
✅ Significant requests from non-urban locations.

✅ Together with drop in cases, query volume has dropped as well.

✅ Now most queries are on vaccination and mucormycosis.

1/3
✅ Large number of queries were on symptoms, knowing when to test, hospitalize, sos prescription etc.

✅ Considering that majority will recover from home, accessible teleconsultation services should be looked at as an effective tool going forward.

2/3
✅ We've seen significant impact with this initiative, especially for those from rural locations.

✅ Teleconsultation services should be made available in EVERY DISTRICT as a first line intervention.

Link to group t.me/CovidMedHelp

3/3
Read 4 tweets
It is not the answer that enlightens, but the question
- Eugène Ionesco

Our experts will answer your questions/doubts on #Mucormycosis, Dental Health and its relation with #COVID19

Join us tomorrow at ⏰11 AM

So, first question..

Are you ready?

🎥 Image
Do you have any question?

Ask and our👩‍⚕️ Doctors🧑‍⚕️will answer your queries on #Mucormycosis, Dental Health and its relation with #COVID19

See you tomorrow at 11 AM

Post your questions in comments section of our webinar👉 Image
Having #COVID19, in the background of diabetes and steroid use, is a classic setting for triple immune suppression: Dr. Rajeev Jayadevan on what makes us prone to catching #mucormycosis

Webinar on Mucormycosis, Dental Health

Watch LIVE now at Image
Read 38 tweets
#MadrasHighCourt will continue hearing #COVID19 related cases today, including a suo motu case to monitor COVID management in Tamil Nadu and Puducherry.

Chief Justice Sanjib Banerjee and Justice Senthilkumar Ramamoorthy to assemble at 2.15 pm.

Track thread for Live Updates.
Court takes up pleas moved to register concern over the safety of workmen who have to work in factories amid the #COVID19 lockdown, since certain industries were exempted from lockdown.

#MadrasHighCourt
Court asks if some consensus has been arrived at between workmen and employers

Senior Adv V Prakash, for workmen, says that some meetings have been conducted.

#MadrasHighCourt
Read 73 tweets
#Maharashtra CM #UddhavThackeray is adressing the state LIVE after nearly a month.

Click the link below to get all the updates on his speech: bit.ly/2SDlCXZ
"Pension and aid for needy 8.5 crore affected individuals has already deposited in beneficiaries account. Over 34 lakh funds given to domestic helps."

Click the link below to get all the updates on CM #UddhavThackeray's speech: bit.ly/2SDlCXZ
"Now the question is, since COVID-19 numbers are slowly dropping should we relax restrictions? The peak this time has come before festivals. Last year it came after festival period"

Click the link below to get the updates on CM #UddhavThackeray's speech: bit.ly/2SDlCXZ
Read 11 tweets
#Mucormycosis and children...! What info do we have? After Covid-19, 16-Yr-Old Fights Mucormycosis, Pancreatitis, Stroke..!! ahmedabadmirror.com/after-covid-19… look at the confidence in this boy..!! Way to go boy..! @iapindia @naveenthacker @vipintukur @ProfSomashekhar @AskDrShashank
“He was operated on for it, his right-side palate and teeth had to be removed, and he is now on medication,” a 13 year old child..!! indiatoday.in/amp/india/stor… @ICMRDELHI @PedCritCareMed @INDIANJOURNALO4
The boy a 15 year old was discharged from the hospital earlier after successfully recovering from the #COVID19 disease in April. Later, he was diagnosed with Mucormycosis. No mention of any risk factors..!! @ARanganathan72 @PMOIndia. hindustantimes.com/india-news/guj…
Read 6 tweets
(1/n) Thread: Epi-immuno-pathogenesis of #BlackFungus, misnormer for #Mucormycosis.
As of 26th of May 2021, India had noted close to 12,000 cases of Mucor along with the #COVIDSecondWave.
The centre has advised it a notifiable disease under Epidemic act.
pib.gov.in/PressReleseDet…
Image
(2/n) Pre #COVID19India, Mucor in India was almost exclusive to patients with uncontrolled diabetes, and usually presented along with DKA.
The other subset was among profoundly immuno-compromised hosts and iron overload states.
(3/n) Interestingly, different etiological risk factors cause various clinical presentations of mucor.
- Diabetes with Rhino-orbital disease
- Solid organ transplant recipients with pulmonary disease
- Disseminated disease in hematological malignancies
doi.org/10.1016/j.cmi.…
Read 25 tweets
Should I take steroids as part of Covid treatment?

Steroids can be LIFE SAVING for Covid.
Use of steroids early in the infection, can be counterproductive, but can be life saving when taken at the RIGHT TIME.

📢 Do not self-medicate. Take steroids only on doctor's advice.

1/4
➡️ A Covid infection can be seen to have 2 phases: The initial phase which is the attack by the virus and the 2nd phase which is the response from our immune system.
The second phase which can happen from the 5th/6th say of infection can cause symptoms to turn severe.

2/4
➡️ Steroids administered during this phase, at the right dosage can help to suppress the storm caused by our own immune system and can be life saving.
➡️ But steroids are a double edge sword. It can cause diabetes to increase and suppress our immune response.

3/4
Read 4 tweets
#Mucormycosis
#BlackFungus

Self medication & procedures like steaming have played a big role in increasing numbers of patients getting infected with fungal infections.

Indiscriminate antibiotic use has killed the normal flora allowing opportunistic infections like fungi to grow
The normal flora has also been destroyed by the indiscriminate steaming which patients & people have done, thinking that will kill the virus.

People have taken zinc supplements indiscriminately & this has allowed fungus to grow as zinc is prerequisite for its growth.
Normally body when infected with fungi sequestrates zinc away from fungus & the monocytes which attack fungus are devoid of zinc. But with plenty of intake of zinc supplements, high blood & tissue levels it is difficult to achieve zero zinc zone around fungi by our immune system
Read 6 tweets
India witnesses steady decline in #COVID19 cases since last 17 days; less than 3 lakh Daily New Cases for eight consecutive days recorded: @MoHFW_INDIA

#IndiaFightsCOVID19
Consistent decline in active cases is recorded since last 22 days; on 10th May 2021 number of active cases were 37,45,237 which is now reduced to 27.20 lakhs active cases: @MoHFW_INDIA
#COVID19 vaccination coverage (As on 24th May, 2021)

People above the age of 45 years: 14.56 crore
Healthcare Workers: 1.65 crore
Frontline Workers: 2.33 crore
People aged 18-44 years: 1.06 crore (first dose)

- @MoHFW_INDIA

#LargestVaccineDrive #IndiaFightsCorona
Read 6 tweets

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