Doctors’ Perception and Management of Fungal Infections

Fungal infections are often neglected by political and social communities. However, they affect more than a billion people, resulting in approximately 11.5 million life-threatening infections and more than 1.5 million deaths annually. India is currently facing a severe second wave of COVID-19 infections and their complications. One of the severe complications arising is mucormycosis and other fungal infections. Some invasive fungal infections carry a high risk of mortality. Hence, timely diagnosis and treatment are essential in curing fungal infections.

Objective: Doctors’ perception and management of fungal infections

A total of 879 doctors participated in the survey, including 47% others, 24% general practitioners, 8% dentist, 5% otolaryngologist, 4% pharmacologist, 3% anesthesiologist, 3% ayurveda, 3% obstetrician & gynecologist and 3% pediatrics.

• Around 52% of the doctors responded that Liposomal Amphotericin B is the choice of medication for antifungal prophylaxis
• A majority of the doctors, 37% responded that symptoms are the choice of diagnosis for fungal infections before starting treatment
• Around 46% of the doctors responded that they frequently come across patients with localized fungal infections
• Around 65% of doctors responded that they commonly observe localized fungal infections on the skin
• Around 54% of doctors responded that Posaconazole is an alternative treatment during the shortage of Amphotericin B amidst the increasing cases of mucormycosis in COVID-19 patients
• Around 34% of the doctors responded that other than steroid overuse, uncontrolled comorbid conditions have contributed to the recent mucormycosis outbreak
• Around 40% of the doctors responded that in case of invasive aspergillosis, liposomal amphotericin B is the first choice
• Around 41% of the doctors responded that nephrotoxicity is the adverse effect of commonly prescribed antifungals
• Around 44% of the doctors responded that surgery or minor procedure is required sometimes to treat fungal infections
• Around 40% of the doctors responded that they rarely recommend measuring serum antifungal levels in a patient

Our survey revealed that, as doctors frequently come across patients with localized fungal infections the diagnosis is based on the symptoms. Around 52% of the doctors responded that Liposomal Amphotericin B is the first choice of medication for antifungal prophylaxis. Amidst the increase in mucormycosis in Covid 19 patients, there is a shortage of Amphotericin B. In such a scenario, 54% of doctors recommended Posaconazole as the alternative treatment. It has been reported that Posaconazole is successfully used in combination or as second-line therapy for the treatment of mucormycosis. Around 34% of the doctors responded that uncontrolled comorbidities contributed to the mucormycosis outbreak. According to evidence, apart, from comorbidities, mainly diabetes, mucormycosis affects immunosuppressed patients due to steroids or patients with a prolonged ICU stay. Physicians should provide patients with adequate knowledge on diabetes management, personal hygiene and probable symptoms of mucormycosis.

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