KNOW
Homoeopathy Journal
E-ISSN: 2583-2158
Bi-Annual, Indexed, Double Blind, Peer-Reviewed, Research Scholarly Online Journal in Field of Homoeopathy
KNOW Homoeopathy Journal
Vol–2 & Issue-1, 15 March 2022, Published at https://www.knowhomoeopathyjournal.com/2022/03/volume-2-issue-1.html
, Pages:
11 to 29, Title: : Homoeopathic Perspective In Post Covid Mucormycosis, Authored By: Dr. Priya Singh (Assistant Professor , Bakson Homoeopathic
Medical College and Hospital)
Title: Homoeopathic
Perspective In Post Covid Mucormycosis
Authored By:- Dr. Priya Singh
Assistant Professor , Bakson Homoeopathic Medical College and Hospital
Cite this Article as:
Dr. Priya Singh, Homoeopathic Perspective In Post Covid Mucormycosis, Vol.2 & Issue 1, KNOW Homoeopathy Journal, Pages 11 to 29 ( 15 March 2022), available at https://www.knowhomoeopathyjournal.com/2022/03/homoeopathic-perspective-in-postcovid-mucormycosis.htmlCLICK HERE TO SEE - PUBLISHER DETAILS
CLICK HERE TO READ - COPYRIGHT POLICY
CLICK HERE TO READ - DISCLAIMER
ABSTRACT:
The term mucormycosis was given by RD
Baker in 1957 and is the common name given to different diseases caused by the
fungi of the order Mucorales. It comes from ‘mucor’ meaning moldy and ‘mycosis’
signifying fungal infection. Mucormycotic fungal infection occurred as a post
complication in coronavirus patients. The whole nation was terrified with the
rising incidence of the black fungus suddenly. However, it needs mention that
the homoeopathic system of medicine is augmented
with adequate therapeutics to resist any form of disease. Be it a new strain of
virus or a rare fungal infection, homoeopathy has been effectively healing ever
since its inception. Therefore, this review was conducted as web-based intense
literature search form authentic database to elicit the pathogenesis, clinical
presentation, and general management of mucormycosis occurring as complication
in coronavirus patients. Further, the homoeopathic authentic textbooks were
reviewed to find out the indicated homoeopathic medicines in cases of post-covid
mucormycosis based on their indications. The purpose of the review is to lay
emphasis on the role of homoeopathy in such cases and collect relevant
information at one place for the ease of medical scholars.
KEYWORDS:
Homoeopathy, Covid associated Mucormycosis, Rhino-Orbito Cerebral Mucormycosis,
Black Fungus
INTRODUCTION:
For many in India, the second lethal wave
of the new coronavirus disease was heartbreaking and a nightmare. The months of April and May 2021
were critical for the whole country. In the month of May 2021, there
were 66,866 fatalities recorded in India due to covid-19, whereas about 70 lakh
infections were discovered in the month of April.[1] As these
figures continued to rise, the whole nation was mourning amidst which Mucormycosis, a
life-threatening disease with a 50% mortality rate (if left untreated)[2],
emerged as another concern among the doctors. Mucorales, often known as
the black fungus, are common moulds that thrive on decaying organic waste in
the environment. Various previous studies from hospitals around the nation have
indicated high mould spore counts even in the hospital air, owing mostly to India's
hot, humid tropical environment. Overuse of steroids and immunosuppression,
particularly in diabetic patients, has been linked to an increase in
mucormycosis co infection in hospitalized corona positive individuals.
Mucormycosis is a rare but deadly illness that may exacerbate the symptoms of
Covid-19 in moderate or severe instances.[3]
Mucormycosis is much less prevalent than
candidiasis or aspergillosis, two other common fungal illnesses. During the
epidemic, however, its prevalence had been rising. Breathing in mucoromycete
spores induces an infection in the lungs or sinuses, which can spread to
other parts of the body and potentially cause death in persons who have a
weaker immune system. The disease is a rapidly progressing infection with poor
prognosis and requires surgical aid. The review was carried out with the aim to
recognize the diagnostic features of the disease and accentuate the usefulness
of the homoeopathic mode of treatment in such rare, opportunistic fungal
infections. With application of the well indicated homoeopathic remedy, not
only the disease prognosis can be improved but the overall rehabilitation of
the diseased individual can be enhanced.
METHODOLOGY:
A web-based search for
post-covid mucormycosis was conducted using reliable databases such as Google
Scholar, Science Direct, and PubMed. The pathophysiology, clinical
presentation, and general therapy of mucormycosis fungal illness that occurs as
a complication in coronavirus patients were comprehensively examined. The
homoeopathic authentic literature was further referred to find out the
indicated homoeopathic medicines in cases of post-covid mucormycosis based on their
indications mentioned in the proving’s. The results of which have been
elaborated for overall therapeutic reference.
RESULT:
J. E. Gregory and colleagues discovered
the first case of phycomycotic infection in a diabetic patient in 1943. They presented
a summary of typical pathology findings in three diabetic ketoacidosis
patients. In 1955, Jerome S. Harris recorded the first instance of
cerebro-rhino orbital mucormycosis (CROM) in a young child with the
characteristic symptomatology of mucormycosis of the central nervous system.[4]
Mucormycosis, also known as zygomycosis,
phycomycosis, or hyphomycosis, is a fungal infection caused by filamentous
fungus belonging to the Mucorales order of the Zygomycetes class. Rhizopus
oryzae is the most often isolated organism from mucormycosis patients,
accounting for over 70% of all cases[5], followed by Rhizopus
microsporus and Mucor circinelloides. Apophysomyces variabilis, Cunninghamella
bertholletiae, Lichtheimia corymbifera, Rhizomucor pusillus, and Saksenaea
vasiformis are some of the less occuring species. There is also evidence of an
inexplicable male gender bias for mucormycosis, with 65 percent of patients
being male.[6,7]
Diabetes, malnutrition, malignancies
(lymphoma and leukemias), renal failure, organ transplant, burns,
immunosuppressive medication, cirrhosis, and AIDS are the probable risk factors.
Mucormycosis is more common in diabetic ketoacidosis patients and those who are
on dialysis. Overuse of corticosteroids, hyperglycemia with HbA1c > 10% [6],
inadequate humidifier maintenance during oxygen treatment, and use of
unsterilized equipment in treating critical patients in the ICU, oxygen or
ventilators are the key etiology in post-covid infection.
Inhalation of air spores, which deposit in
the paranasal sinuses and lungs, is the main route of infection. Ingestion of
contaminated food or abrasion of the skin are two other less common ways.
Following nasal infection, it spreads rapidly to surrounding tissues, including
the orbit, and sometimes to the brain. Hematogenous diffusion to additional
target organs is most likely aided by angioinvasion (Figure1)[8].
The main host defensive mechanism against mucormycosis is mononuclear and
polymorphonuclear phagocytes. Mucorales are killed by the production of
oxidative metabolites and cationic peptides, such as defensins. The
multiplication of fungal spores is then inhibited by neutrophils.
Corticosteroids and immunosuppressants greatly enhance these effects in
coronavirus patients. Neutrophil migration, ingestion, and phagolysosome fusion
are all hampered by corticosteroids. Along with the possible implication of
steroid-induced hyperglycemia, diabetic covid 19 patients under steroid therapy
and other immunosuppressant drugs are vulnerable to the infection with
mucormycosis.
Clinical signs of mucormycosis differ
depending on the location of infection, however they always show fast
development. The rhino-orbito-cerebral (ROCM) type of post-covid co infection
with mucormycosis is the most prevalent and severe variant, affecting the
sinuses and para-sinuses in debilitated individuals. Infection occurs in three
phases throughout the clinical development of ROCM (Table1) [9, 10]
 |
| Table 1: Clinical Progression of Rhino-orbito-cerebral Mucormycosis |
Pulmonary mucormycosis, cutaneous/skin
mucormycosis, gastrointestinal mucormycosis, and disseminated mucormycosis are
some of the other kinds of mucormycosis infection. Only a few instances of
pulmonary mucormycosis have been reported after a coronavirus infection in
which the lungs have been infected with the fungal invasion. Patients may
develop bilateral pneumonia, hemoptysis, dyspnea, and cough that advance
quickly. Mucormycosis of the skin, presents as a single indurated area of
cellulitis that progresses to a necrotic lesion and forms abscesses, and
mucormycosis of the gastrointestinal tract, presents as nausea, vomiting,
bleeding with necrotic ulcers and bowel infarcts, and have both been observed in
post-covid infection[5]. The fungus may travel extensively through
the bloodstream, causing a wide range of indications and symptoms depending on
the organ system affected. Mucormycosis may impact or spread to the kidneys,
the inner lining of the heart chambers and heart valves (endocarditis), and the
bone in rare cases (osteomyelitis).
A complete patient history, identification
of distinctive symptoms, and a thorough clinical assessment are used to make a
diagnosis. The symptoms are similar to many illnesses, including various forms
of infection, making diagnosis difficult. Diagnosis is mostly challenging
because the symptoms are common to many conditions including other types of
infection. The diagnostic tools include direct examination: KOH mount and
Calcofluor, Fungal culture, Quantitative PCR of blood, MALDI-TOF mass
spectrometry, Computerized tomography (CT) scan of lungs, sinuses, facial
structures and MRI[11] are among the diagnostic techniques. Post
covid-19 coinfection with mucormycosis can be prevented by taking suitable
measures. These include: -
1. Serious patients, particularly those at
high risk, should not be kept in dusty regions since the fungus flourishes in
dust and building materials (diabetic, immunosuppressed cases)
2. The patient must wear a decent mask and
take the necessary measures, such as keeping his or her hands clean.
3. Blood sugar levels must be closely
monitored. The fungus thrives on high sugar levels.
4. The patient should get plenty of rest
and drink plenty of water.[12]
Conventionally, antifungal drugs are administered
intravenously or orally to patients with mucormycosis. Surgical debridement is
used to remove sick or dead tissue, as well as damaged skin and subcutaneous
tissue.[6]
HOMOEOPATHIC PERSPECTIVE:
Clinical researches are required to build a
scientific database relevant to homoeopathy in order to fulfill the needs of
the contemporary world. It is clear that Post covid-19 mucormycosis is a
non-infectious, dangerous, and life-threatening condition. There is no evidence of any study on mucormycosis in relation to homoeopathy. However, In this article an
effort has been made to write down a set of drugs based on their broad
indications, following the criteria mentioned by AYUSH regulatory agencies and simultaneously
referring homoeopathic literature. The homoeopathic drugs that may be
administered using homoeopathic principles in instances with rhino-orbito
cerebral mucormycosis are briefly detailed below [13,14].
1. ARSENIC ALBUM- It covers all miasmatic influences adequately. The skin on the nose becomes desquamated. The face gets swollen with decomposed skin, and distorted facial bones. Inflammation of the eyes and lids, with severe burning pains, preventing the opening of the eye. One of the main characteristics of the remedy is burning with sharp and drawing pains.
2. AURUM METALLICUM- Aurum metallicum causes a dull, tearing pain in the skull bones that quickly progresses to inflammation and necrosis. The main symptoms are dental caries in the nasal bones and bone pain in the nasal bridge with a fetid odor. Inflammation and suppuration in the eyes with protruding eyeballs. The patient may suffer from paralysis of optic nerve with horizontal half vision.
3. BISMUTH- Complete indifference with pressure and a sensation of weight in the forehead, temples, and occiput, as well as pressure on the eyes. Sensation of outward digging in the forehead, orbits, and root of nose. The complaints are worse in the afternoon, after eating and rest. Motion, touch, and washing are all beneficial. With pressive pains in zygoma, there is pressure on the eyeballs.
4. CINNABARIS- There is heat of the face and swelling, mostly seen around the eyes. There is sensation of uneasy creeping and pressing sensation about nasal bones. Suitably effective in shooting pains felt in the inner canthus of the right eye, with burning and itching. Inflammation of right eye with profuse discharge of mucus from the nose are see in the medicine.
5. CARBO ANIMALIS- Ulceration, gangrenes, and decomposition are marked effect of this remedy due to its antiseptic properties. A sense of looseness-of eyeballs in sockets is a feature of the medication. There may be presbyopia with dilation of the pupils. The bones of the nose have a painful sensitivity. Shooting sensations are felt in the cheek bones.
6. ECHINACEA ANGUSTIFOLIA- This medicine is used to treat acute infections, blood poisoning symptoms, and septic conditions in general. Neuralgic aches are mainly felt at the back of the right eye. Suitable for acute pains in the right eye and temples, as well as lachrymation and a feeling of warmth in the eyes while closed. When picking causes hemorrhage, there may be bleeding and soreness on the right side of the nostril.
7. GUN POWDER- Gunpowder is a combination rather than a chemical substance. Suppuration, mostly septic, is associated with gun powder. The most common indication for this drug is blood poisoning, where it acts as a preventative measure.
8. KALI-IODATUM- This medicine is mostly used to treat left-sided ailments. Tearing aches are felt behind the left eye when you first wake up in the morning. Edematous cellular tissue surrounding the eyes, with protrusion of the eyeballs. Light sensitivity combined with dim, double, or distorted vision. Heat in the nasal sinuses and acrid discharge from the anterior nares are reported by the patient. The individual has stiffness and distension of the cheeks and submaxillary regions.
9. KALI-BICHROMICUM- This medicine has been shown to be effective in treating bone pain and syphilitic ulcers. There is a pressure sensation in the nasal bones that extends to the frontal sinuses, along with discomfort and burning. The orbital bone is swollen and aching. Violent shooting pains with pressure along the left orbital arch and at the root of the nose. A pinching ache in the nasal bridge is relieved by applying forceful pressure. The nasal septum becomes ulcerated.
10. MERCURIUS BIN-IODATUS- This medication affects the lymphatic system and cellular tissue. It primarily affects the left side of the body. After sleeping, in the afternoon, and in the evening, the symptoms worsen. It is appropriately indicated in disorders of the nasal bones. The turbinates are enlarged and there is crusty eruption on wings of nose. Inflammation with burning and watering in the eyes which is increased by bright light. Face ache in the left cheek and eye.
11. MERCURIUS PROTOIODATUS- The patient complains of shooting pains in the forehead, right orbital superior arch, and nose root. The right side of the septum and the right nostril are swollen and painful. The nasal septum, eyeballs, and orbits all have acute aches. Soreness of all the face bones, with dull frontal headache. There is right sided affinity of the medicine and night aggravations.
12. MYRISTICA SEBIFERA- It is a medicine with outstanding antibacterial capabilities. There is inflammation of skin, cellular tissue, and periosteum in general. The remedy is suited in phlegmonous inflammations, has the power to hasten suppuration and shorten its duration. Dr. William Boericke has mentioned that its use often does away with use of the knife.
13. MERCURIUS VIVUS- An inflamed eye with a light sensitivity. Under the eyelids, there are ulcerations and cutting pains. The visual nerve is gradually paralyzed, and there is an aversion to light. Swelling of the bones of the nose, nasal bridge may swell up very large on both sides with painful sensitiveness to touch. Swelling on the face mostly around the eyes. Swelling on the right side, with heat and toothache.
14. PHOSPHORUS- Puffy face with tearing pains in facial bones. There is pressure in the eyes, as though from a particle of sand, as well as irritation. The upper eyelids are swollen, and moving them is difficult. Patient perceives a terrible dryness in the nose and fetid odor.
15. SILICEA- The remedy covers ulcers and fungus hematodes on the cornea. Ulcers with gnawing pain high up in the nose, with great sensitiveness to touch. Acrid, acidic nosebleed with a constant feeling of dryness in the nose. There may be loss of smell. Tearing pains on one side, especially on the right, that stitch out through the eyes and facial bones.
16. THUJA OCCIDENTALIS- JH Clarke mentions Fungus tumor in the orbit. Thuja masks a sewing ache in the middle of the left eye. The eyelids are swollen and hardened due to inflammation. Tensive ache in the nasal bone. Touch relieves boring and digging pains in the cheek bone. Pain in left cheek bone spreading from teeth to nose, to eyes to temples into head. The painful spots burn like fire and are extremely sensitive to the rays of the sun.
DISCUSSION AND CONCLUSION:
Homoeopathy is a well-known alternative
therapy around the world. As per homoeopathic principles, all diseases
occurring in nature are due to disturbances in the vital force of any
individual presenting as signs and symptoms. As a result, homoeopathy's
holistic and personalized approach may successfully aid humanity in any
uncommon illness. The similimum is decided after constructing a totality of the
symptoms, including both mental and physical domains of the patient. The
strategy in homoeopathy is not only to cure mucormycosis illness but also
increase the patient’s vitality and eradicate any fundamental/ sustaining
causes.
Homoeopathic Materia Medica is enriched
with medicines that help to cure any disease occurring in nature. Fungal infections can be treated with homoeopathic
medicines and several in vitro effects of homoeopathic drugs preventing growth
of various strains of fungus have been carried out in the past. Being
a rarely occurring infection, much evidence on the role of homoeopathy in
mucormycosis has not been yet established. Though, employing homoeopathic medicine
as per indicated symptomatology will relieve the suffering humanity. In such a
global crisis where, every individual is affected in some way, use of natural
healing art of homoeopathy can help rejuvenate naturally. CONFLICT OF INTEREST: The author declares no conflict of interest.
REFERENCES:
1. Sinha A Explained: Why Covid-19 deaths are spiking as the caseload is going down. The Indian Express [Internet] 2021 May 18 [cited 2021 May 21] Available from: https://indianexpress.com/article/explained/india-coronavirus-numbers-spike-in-deaths-cases-peak-7320010/
2. Ghosh S. Post COVID infections wrongly addressed as Black Fungus: Experts. The New Indian Express [Internet] 2021 May 17 [cited 2021 May 21] Available from:
https://www.newindianexpress.com/cities/delhi/2021/may/17/post-covid-infections-wrongly-addressed-as-black-fungus-experts-2303516.html
3. Garg D, Muthu V, Sehgal IS, Ramachandran R, Kaur H, Bhalla A, Puri GD, Chakrabarti A, Agarwal R. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature. Mycopathologia [Internet]. 2021 May [cited 2021 Jun 26];186(2):289-298. Available from: https://pubmed.ncbi.nlm.nih.gov/33544266/ doi: 10.1007/s11046-021-00528-2
4. Wali U, Balkhair A, Al-Mujaini A. Cerebro-rhino orbital mucormycosis: an update. J Infect Public Health [Internet]. 2012 Apr [cited 2021 Jun 30];5(2):116-26. Available from: https://pubmed.ncbi.nlm.nih.gov/22541257/ doi: 10.1016/j.jiph.2012.01.003.
5. Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis [Internet]. 2012 Feb [cited 2021 July 1];54 Suppl 1(Suppl 1):S16-22. Available from: https://pubmed.ncbi.nlm.nih.gov/22247441/ doi: 10.1093/cid/cir865
6. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis [Internet]. 2005 Sep 1 [cited 2021 July 1];41(5):634-53. Available from: https://pubmed.ncbi.nlm.nih.gov/16080086/ doi: 10.1086/432579
7. Hernández JL, Buckley CJ. Mucormycosis. [Updated 2020 Jun 26]. In: StatPearls Treasure Island (FL): StatPearls Publishing [Internet]. 2021 Jan. [cited 2021 July 12]. Available from: https://pubmed.ncbi.nlm.nih.gov/31335084/
8. Satish D, Joy D, Ross A, Balasubramanya. Mucormycosis coinfection associated with global COVID-19: a case series from India. Int J Otorhinolaryngol Head Neck Surg [Internet]. 2021 [cited 2021 July 15];7:815-20. Available from: https://www.ijorl.com/index.php/ijorl/article/view/2890 doi: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20211574
9. Onerci M, Gürsel B, Hosal S, Gülekon N, Gököz A. Rhinocerebral mucormycosis with extension to the cavernous sinus. A case report. Rhinology [Internet]. 1991 Dec [cited 2021 Jun 20];29(4):321-4. Available from: https://pubmed.ncbi.nlm.nih.gov/1780635/
10. Chikley A, Ben-Ami R, Kontoyiannis DP. Mucormycosis of the Central Nervous System. J Fungi (Basel) [Internet]. 2019 Jul 8 [cited 2021 July 21];5(3):59. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787740/ doi: 10.3390/jof5030059
11. Thomas J. Walsh, Maria N. Gamaletsou, Michael R. McGinnis, Randall T. Hayden, Dimitrios P. Kontoyiannis, Early Clinical and Laboratory Diagnosis of Invasive Pulmonary, Extrapulmonary, and Disseminated Mucormycosis (Zygomycosis), Clinical Infectious Diseases [Internet]. 2012 Feb [cited 2021 July 26]; 54 suppl_1:S55–S60. Available from: https://pubmed.ncbi.nlm.nih.gov/22247446/ doi: 10.1093/cid/cir868
12. Mucormycosis_Management_COVID19, ICMR [Internet]. 2021 [cited 2021 July 27]. Available from: https://www.icmr.gov.in/pdf/covid/techdoc/Mucormycosis_ADVISORY_FROM_ICMR_In_COVID19_time.pdf
13. Boger C.M., Boenninghausen's Characteristics Materia Medica & Repertory, With Corrected & Revised Abbreviations & Word Index. New Delhi: B. Jain Publishers (P) Ltd.;2009
14. Clarke J.H., A Dictionary of Practical Materia Medica. New Delhi: B. Jain Publishers (P) Ltd.;2005
KNOW Homoeopathy Journal
Volume-2 | Issue-1 | March-2022
