Immunity compromised patients are those who have very low levels of immunity and therefore are not equipped to withstand attacks from pathogens like fungus. This makes them vulnerable to a host of diseases and infections. It is estimated that around 10 per cent to 15 per cent of fungal infection cases occur in hospital settings and carry high risks of mortality and morbidity. People who suffer with compromised immunity are mostly those who undergo critical surgeries and consume high dosage of drugs as part of prescribed therapy, for example patients who suffer with HIV, cancer or uncontrolled Diabetes.
Treatments like chemotherapy further suppresses the immune system to enable medicines to work. Incase of organ transplant it becomes necessary to suppress immunity so that the new organ is accepted by the body, which would otherwise be rejected by the natural immune system. Unprescribed or prolonged antibiotic abuse, consumption of steroids and other factors may also contribute to low immunity.
Aspergillosis and candidiasisare the most common invasive fungal infections that occur in hospitals. They can be community acquired as well, especially from soil or environmental pathogens. The infections tend to flare up and manifest in the hospital when the patient is undergoing some other treatment and the immunity is low.
Fungi are common in our natural environment. It is almost impossible to have a 100 per cent uncontaminated space, even in hospitals. In many cases the infection already exists in latent state in patients.
Invasive fungal infections are difficult to diagnose and treat. Quite often doctors identify these infections by using various diagnostic testing like surrogate markers. Fungal infections may also require prolonged treatment that may last for around six weeks.
Immunity compromised patients undergo heavy medical treatment for their serious illnesses. Contracting invasive fungal infection during this period makes cases more complicated as doctors need to balance the treatment of major medical conditions like cancer, organ transplant, surgery and others, while treating patients with adequate antifungal therapy to boost immunity. Doctors have a well-measured approach to start antifungal treatment in appropriate dose and duration.
Invasive fungal infections are associated with prolonged hospital and ICU stays, prolonged recovery, increased cost, and high mortality. Hospitals deploy various measures to control invasive fungal infection or hospital acquired infections like avoiding prolonged indwelling catheters, antibiotic stewardship, adhering to antibiotic guidelines, and conducting regular surveillances.
Early identification of the infection and taking precautions are important steps to prevent the diseases. Technological advancement has made quick diagnosis possible. In addition, better medical expertise and availability of quality medicines have improved the management and treatment of these infections.
Awareness plays a key role. Immunity compromised patients and their families, especially in a community setting, should be alert for symptoms like fever, headache and especially swelling of the eyes. Although these symptoms may be due to innocuous infections, sometimes they signal invasive fungal infections and hence should be reported to the doctor immediately. Consumption of over-the-counter antibiotics or drugs should be avoided.
Following hospital rules at hospitals and at home is helpful in warding off the infections. Visitors should not bring flowers as they often harbour fungal spores. Immunity compromised people should avoid activities like gardening, trekking in the forests or green belts. Construction sites should also be avoided. Due to increased pollution levels and air borne infections using N95-99 masks is suggested for patients while venturing out. This can prevent fungal spores from entering the rooms. Patients should avoid being near pets or bird droppings, as they are carriers of fungal infections. In terms of food, soft over-ripe fruits, black spots on vegetables like onions and greenish spots on bread should be avoided.
The writer is Dr Prashant Saxena Head, Pulmonology, Critical Care & Sleep Medicine, At Max Smart Superspeciality Hospital, Saket, Delhi
