Mucor due to hyperglycemia from new strain?

A tweet from the Head of Dept, Rheumatology, AIIMS, New Delhi questioned the current notion that steroids could be the cause of sudden surge seen in mucormycosis cases.

Used #steroids in lakhs of rheumatology patients for weeks but never witnessed such numbers of #Mucormycosis as within last few weeks. Is it Covid playing with the immunity to invite #Mucormycosis or the use of industrial #Oxygen during crisis? @ICMRDELHI @drharshvardhan

— Prof. (Dr) Uma Kumar (@_Rheuma) May 20, 2021

Her tweet, which suspected an interaction between COVID-19 and immunity being responsible for mucormycosis, received a prompt response from Dr. Om Lakhani, consulting endocrinologist, Zydus hospitals who suggested 'poor glycemic control' as the key factor behind mucormycosis surge.

It is NOT steroids, oxygen supply, remdesivir or animal excreta. It is POOR GLYCEMIC CONTROL which is causing Mucormycosis.

COVID-19 itself produces hyperglycemia.

Control the blood sugars. https://t.co/UnOIaEO884

— Dr. Om Lakhani, MD, DNB (ENDO) (@omlakhani) May 22, 2021

Dr. Lakhani suggests that our current notion that mucormycosis was mainly seen in hospitalized patients is wrong. He also questioned the current claims of oxygen supplementation being responsible for mucormycosis.

The maximum patients with Mucormycosis we saw last month were Home treated without supplemental oxygen. All were having hyperglycaemia. Hyperglycaemia was the ONLY common parameter amongst these patients.

— Dr. Om Lakhani, MD, DNB (ENDO) (@omlakhani) May 22, 2021

Dr. Lakhani suggests severe hyperglycemia caused by the new strain as the key factor behind mucormycosis.

Even though the earlier strain caused hyperglycemia, it was not that severe. The current strain is causing severe hyperglycemia.

This strain however causes tremendous hyperglycemia. Hence we are seeing more cases.

— Dr. Om Lakhani, MD, DNB (ENDO) (@omlakhani) May 22, 2021

However, it is not just hyperglycemia but its interaction with COVID-19 that is causing mucormycosis.

COVID + HYPERGLYCEMIA = MUCORMYCOSIS

Not hyperglycemia alone

— Dr. Om Lakhani, MD, DNB (ENDO) (@omlakhani) May 22, 2021

He suggests the use of Insulin and Oral Antidiabetic Drugs (OAD) for the management of hyperglycemia.

Insulin +/- OAD

— Dr. Om Lakhani, MD, DNB (ENDO) (@omlakhani) May 22, 2021

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