PROTOCOL FOR PREVENTION OF MUCORMYCOSIS BY MINISTRY OF AYUSH

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 India has been battling with a significant rise in COVID-19 cases in the second wave.

  • A severe and rare fungal illness, Mucormycosis also known as “black fungus”, affecting somecoronavirus patients is causing a double blow to the country. 
  • Mucormycosis infections aremore severe in people with comorbid conditions like Diabetes, Hypertension etc. and immune-compromised state.
  •  Because of the increase in the number of patients with this deadly infection ,many states have declared Mucormycosis as an epidemic and has become a matter of hugeconcern. 
  • Mucormycosis is classified mainly into five types depending on the part of the bodyaffected. 
  • The clinical features described of Rhino-orbito-cerebral Mucor mycosis are similarto Raktaja Pratishyaya and Krimija Shiroroga (unilateral facial swelling, Headaches, Nasalcongestion, Nasal discharge, Fever etc). 
  • Presentation of Pulmonary Mucormycosis are verymuch similar to Kshayaja Kasa, (Cough with pericardial chest pain, foul smelling, greenish,purulent, mucoid and blood stained/ haemoptysis sputum and cough associated with fever(jvaro-mishrakriti) or chest pain (Parshvaruka) or recurrent coryza (Pinasa) are the clinicalfeatures found in Pulmonary Mucourmycosis. 
  • The Gastrointestinal Mucormycosis can beincluded under the spectrum of Udara roga especially Sannipatika udara roga and pathogenesisof Disseminated mucormycosis in later phase can be compared with Dushtavrana 
  • where as Cutaneous mucormycosis can be correlated with Kushtha and Visarpa.
  • Breaking the cycle of infection, boosting an individual’s immune system, detecting theinfection early, and providing proper medical care are the best ways to avoid Mucormycosis.
  • The Ayurvedic principle of management includes Kledahara, Pramehahara, Agnivardhaka Aampachaka, Krimihara, Ojovardhaka, Rasayan and Balya chikitsa.
  •  Therefore, to dealwith the Mucormycosis infection, Ayurvedic Immuno-modulatory supplements coupled withCovid-19 management regimen may be started at earliest as prophylaxis.

General disclaimer

 Physicians have their own discretion to select drugs based upon the stage of the disease,Complexity of symptoms, availability of the medicines in their locality and dose/durationhas to be decided according to condition/stage of disease. Patients need to have a general consultation/advice of qualified physicians before startingany intervention.

 Patients in whom already some medications are going on for health issues such ashypertension, diabetes, cancer chemotherapy etc. are to be continued.

 This is for the use of physicians only and strictly not intended for self-medication bypatients. Use the medicines under the prescription of registered medical practitioners only.

 It is the responsibility of the practitioner, lying on his or her own experience and knowledgeof the patient, to make a diagnosis, to determine combinations, dosages and best treatmentfor each patient, and to take all appropriate safety precautions. List provided gives an ideaabout the different drugs of choice available for the said condition. Physician may selectmedicines from the list provided above or other than the list as per the complaints andavailability.

 This document contains the collective views of a group of experts. Use these medicines is subject to Epidemic Disease Act and Disaster Management Act, if at all applicable. It is thephysician’s responsibility to check with local applicable laws. Contributors are no-way heldresponsible for the same.

How to prevent

Dos 

1. Proper nutrition is to be ensured through freshly cooked, warm, light diet like greenvegetables, Moonga dala, Masoora Daal, Daliya, Soup etc. considering individual’s Agni(digestive power).

2. Intake of Herbal tea (Ayush kaada)/ Medicinal water should be used as a regular drink to maintain hydration (As per AYUSH COVID -19 guidelines.).

3. Adequate sleep of 7-8 hours at night is essential and should be encouraged.

4. Maintain personal hygiene.

5. COVID appropriate behaviour and general protective measures advised by health authorities such as social distancing, using appropriate mask properly, hand washing andsanitization, vaccination etc. for Covid-19 must be followed.

6. Control hyperglycaemia and consult the physician accordingly if required.

7. Use clean sterile water for humidifiers during oxygen therapy.

8. Follow the guidelines published time to time by Ministry of AYUSH & MoHFW, ICMR.

Don’ts 

1. Do not miss warning signs like facial swelling, headache, blackish lesions in oral/ nasalcavity, bulging out of eyeballs, difficulty in breathing, fever etc particularly in the contextof immunosuppression and/or COVID-19 patients on steroid and oxygen support.

2. Avoid fermented food items, refrigerated items, cold drinks, packed food, junk food etc

3. Do not lose crucial time to initiate treatment for Mucor mycosis.Do not lose crucial time to initiate treatment for Mucor mycosis.

4. Avoid self-medication.

5. Do not sleep during the daytime.

Prophylactic Measures

Daily regimen

1. Daily practice of Yogasana, Pranayama and meditation for at least 30 minutes as advised by Ministry of AYUSH.

2. Kavala/Gandusha (Gargling) with lukewarm water along with an added pinch ofturmeric/Triphala/ Panchavalkala or Sphatika.

3. Nasya (Nasal instillation/ application of medicated oil) - (Anu taila or Shadbindu Taila) orcow ghee (Goghrita), once or twice a day, especially before going out and after coming  back home.

4. Steam inhalation with Karpur (Camphor) or Eucalyptus oil (1-5 drops) or Ajwain(Trachyspermum ammi), Pudina (Mentha spicata) once a day.

5. Dhumapana with Guggulu (commiphora mukul), Nimba (Azadirachta indica), Haridra (Curcuma longa), Agaru (Aquilaria agallocha), Devadaru (Citrus devdar) or Aparajita(Clitoria ternatea) mixed with ghee/Oil.

6. Frequent intake of water prepared with Shunthi (Zingiber officinale), Dhanyaka(Coriandrum sativum), Musta (Cyperus rotundum), Tulasi (Ocimum sanctum), Lavanga(Syzyium aromaticum) or Jeera (Cuminum cyminum) seeds.

7. Drinking of Golden Milk (Half tea spoon Haldi (Curcuma longa) powder in 150 ml hot  milk) once at night, but should be avoided in case of indigestion.

The medicines listed in the below table as prophylactic can be used alone or along with theother medicines listed in different types of Mucormycosis accordingly.

Post-COVID-19 regimen for preventing opportunistic infections/Prophylactic

  1. Dashmoola kwatha, 
  2. Manjishthadi Kashaya, 
  3. AaragvadhadiKashaya 
  4. sanshamani Vati,
  5.  Arogyavardhini vati, 
  6. Chandraprabha vati
  7. Kaishor Guggulu,
  8.  Triphala Guggulu, 
  9. Laxmi Vilas Rasa
  10.  krimikuthar Rasa,
  11.  Gandhak Rasayana
  12. Amritarishta, 
  13. Vidangarishta / Vidangasava
  14.  Kumari Aasava
  15. Chyavanaprash Avaleha,
  16. Chitraka Haritaki Avaleha
  17. Nisha-Amalaki Churna,
  18. Sitopaladi Churna, 
  19. AvipattikarChurna, 
  20. Sudarshana churna
  21. Guggulutikta ghrita,
  22.  Jeevantyadi Ghrita
THIS MEDICATION SHOULD BE TAKEN UNDER GUIDANCE OF MEDICAL PRACTITIONER

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