As per the new guidelines issued by Director General of Health Services (DGHC) under the Union Health Ministry, Black Fungus is a serious fungal infection seen in patients with previous conditions like immunosuppression, poorly controlled diabetes mellitus, misuse/overuse of steroids, cancer, organ/stem cell transplantation, and those under prolonged ICU treatment.
Under the guidelines, DGHC has advised not to wait for culture results to initiate therapy as mucormycosis is an emergency. “Early complete surgical debridement is the cornerstone of treatment, and maybe repeated as required,” the DGHC said in its guideline.
According to the guidelines, “Conventional Amphotericin B as a prolonged IV infusion through a central venous catheter or PICC; closely monitor kidney function and electrolytes during treatment. Reconstitute in water for injection, and dilute in 5 per cent dextrose (do not use normal saline/Ringer’s lactate, start with test dose: 1 mg IV infusion over 20-30 minute. Loading dose: 0.25-0.5 mg/kg IV infused over 2-6 hours; gradually increase by 0.25 mg-increments/day to reach maintenance dose: 1-1.5 mg/kg/day.”
“Liposomal Amphotericin B or Amphotericin lipid complex, if available; prolonged infusion over 2-3 hours through a central venous catheter or PICC and closely monitoring KFT and electrolytes. Reconstitute in water for injection, and dilute in 5 per cent dextrose (do not use normal saline/Ringer’s lactate); start full dose from first day; 5 mg/kg/day (10 mg/kg/day in case of CNS involvement),” it said.
It has also advised saliva therapy for cases who cannot be given Amphotericin B. Children below 11 years of age should be given – 7-12 mg/kg/dose IV twice on the first day and maintenance dose – 7-12 mg/kg IV once a day, starting on the second day,” it added.