MUCORMYCOSIS

A Conceptual A#yurvedic Approach

Dr. L.Mahadevan,MD, Ph.D(Ayu)

Dr. G. Aishwarya, BAMS.
Dr. Vinay Chaudhary, BAMS, MD.
 Doctors Team

Dr. L.Mahadevan,MD, Ph.D(Ayu)

Director
Dr. Y. Mahadeva Iyer’s Sri Sarada Ayurveda Hospital
Derisanamcope, Azhagiapandiapuram Post
Kanyakumari Dist - 629851, Tamilnadu.
&
Professor
Dept of Kayachikitsa & PG Studies
Pankajakasthuri Ayurveda Medical College,
Killy, Kattakkada

Mobile No: + 91 94433 62982

E-mail: [email protected]

Dr. G. Aishwarya, BAMS.

Medical Officer
(Disciple of Dr. L. Mahadevan)
Dr. Y. Mahadeva Iyer’s Sri Sarada Ayurvedic Clinic,
Besant Nagar, Chennai.

Mobile No: +91 7550 187185

E-mail: [email protected]

Dr. Vinay Chaudhary, BAMS, MD.

Medical Officer
(Disciple of Dr. L. Mahadevan)
AYUSH, Sonepat, Haryana
Member of Drug Licensing Authority, AYUSH, Haryana State

www.saradaayurveda.com

DISCLAIMER
Mucormycosis has been declared as an epidemic in many states of India.
It is a devastating disease that can cause mortality and may lead to removal of
the affected part. We are presenting a conceptual study on mucormycosis and
formulated a treatment protocol. This is for circulation among BAMS students and
A#yurveda Vaidya#s. We keep in mind that based on Avastha, the treatment methods
may vary from Vaidya to Vaidya.
2
WHAT IS MUCORMYCORSIS

• Mucormycosis
(sometimes called zygo
mycosis) is a serious but
rare fungal infection
caused by a group of
fungal moulds called
Mucormycetes. 
• These fungi live
throughout the
environment,
particularly in soil and
in decaying organic
matter, such as leaves,
compost piles, or rotten
wood.
 RISK GROUP
Diabetes, especially with diabetic ketoacidosis( It is a serious
complication of diabetes that occurs when your body produces high
levels of blood acids called ketones)
Cancer
Organ transplant
Stem cell transplant
Neutropenia (low number of white blood cells) N.Value – 45-75% WBC
Long-term corticosteroid use
Injection drug use
Too much iron in the body (iron overload or hemochromatosis) –Normal
value of iron - 60 to 170 mcg/dL)
Skin injury due to surgery, burns, or wounds
Prematurity and low birth weight (for neonatal gastro-intestinal
mucormycosis)
Industrial oxygen may have fungal spores that may have been a reason
for outbreak of mucormycosis

TYPES OF MUCORMYCOSIS
Rhinocerebral (sinus and brain) mucormycosis
Pulmonary (lung) mucormycosis 
Gastrointestinal mucormycosis 
Cutaneous (skin) mucormycosis
Disseminated(widespread) mucormycosis

4
RHINOCEREBRAL (SINUS AND BRAIN) MUCORMYCOSIS
 COMMON SYMPTOMS
TYPE OF MUCORMYCOSIS SYMPTOMS
Rhino Cerebral Mucormycosis • Unilateral facial swelling
(Most Common) (Diabetic/ Renal • Headaches
Transplant Patients) • Nasal / sinus congestion/pain
• Serosanguinous (fluid that is both serous and
bloody) nasal discharge
• Fever
Pulmonary mucormycosis • Non-specific symptoms
(most common) • Fever
(hematologic malignancy & • Cough
neutropenic patients) • Chest pain
• Dyspnoea

CT SCAN OF PULMONARY MUCORMYCOSIS

• Computed tomography of the chest showing the reversed halo sign.

Central ground glass opacities (arrow) are surrounded by areas of peripheral
consolidation (arrow head).
• The reversed halo sign may be considered pathognomonic of pulmonary
mucor mycosis in the right clinical context

6
 COMMON SYMPTOMS
TYPE OF MUCORMYCOSIS SYMPTOMS
Cutaneous skin mucormycosis • Primary infection
(Direct inoculation of the fungus into • Acute inflammatory response with pus
disrupted skin – burns, injuries) formation
• Abscess formation
• Tissue swelling
• Necrosis
• Lesion progresses to black eschars (dry,
black necrotic tissue)
• Secondary infection
• Typically begins as a an erythematous,
indurated, and painful cellulitis & then
progresses into an ulcer covered with
black eschar

CUTANEOUS MUCORMYCOSIS
 COMMON SYMPTOMS

TYPE OF MUCORMYCOSIS SYMPTOMS

Gastrointestinal mucormycosis • Non-specific abdominal pain and distension,
(Less common type ) • Nausea
Affected group- neonates • Vomiting
D/D – Necrotising entero colitis • Gastro intestinal bleeding may occur
Disseminated Mucormycosis • Seen followed by other types of mucormycosis
• The infection spreads from the actual site and
spreads to other part of the body.
• Common site affected – brain

DIAGNOSIS
Radiological Study- X-Ray
Tissue Biopsy
MRI- brain, orbit, PNS (Rhino cerebral)
Computed Tomography (CT Scan) of the lungs, sinuses and other
parts of the affected parts.

8
 COVID ASSOCIATED MUCORMYCOSIS

The two important factors contributing to Mucormycosis in India

Uncontrolled Diabetes
Widespread Use of Cortico steroids
Use of Corticosteroids have been the only promising treatment
in severe cases of COVID 19 in Modern Medicine.
However, it leads to Hyperglycemia that favours secondary
infections like Mucormycosis.
Rhino Orbital Mucormycosis have been the most frequent
presentation.
Mortality rate – 49%
Furthermore, a significant proportion of surviving patients
suffered life-changing morbidities (loss of vision in 46% of
survivors).
Most commonly used treatment for mucormycosis in patients in
modern medicine include –
Anti fungal therapies – Most commonly lipid formulations of
Amphotericin B (Antifungal medication used for serious fungal
infections)
Surgical removal of affected parts (In order to prevent further
spread of the fungal infection)
 MUCORMYCOSIS IN A#YURVEDA
Nida#na
Prameha / Prameha upadrava
Ojoks8ayam
Stha#nam – kapha stha#nam (Ura, ghrana, kan8t8a, s$ira )
Laks8an8am
(With specific reference to Rhinocerebral Mucormycosis)
A#ma avastha – Jvara, Na#sarodha
Pacyama#na avastha – Jvara, mukha s$opha, pratis8ya#ya, raktapitta, s$u#lam
Pakva# avastha – Mukha s$opha, rakta vidagdha, dha#tupa#ka

Sampra#pti
There are 4 important factors that contribute to the sampra#pti
Kleda vr8ddhi – as seen in prameha
Ojoks8ayam – Vya#dhi aks8amtavm
Dha#tu daurbalyam – Vya#dhi ru#pam
Pitta vidagdha – S$i#grapa#ki
Laks8an8a stages
STAGE I – Kaphapradurbhava
STAGE II - Kaphavilayanam – Pitta dus8t8i
STAGE III - Pitta vidagdha – Va#ta pradurbhavam

Dos8a#s - Kapha, Pitta, Va#ta

Du#s8ya- Rasa, Rakta, Ma#msa, Medas
Treatment Protocol
Kas8a#ya Tikta Rasa Prayoga
Rakta Prasa#danam
Ojo Vr8ddhi
Kr8mighna
Initially, Kapha pitta haram, Ru#ks8a,

10
 MUCOR MYCOSIS IN A#YURVEDA - Stage I
Kas8a#yam
A#ragvada#di kas8a#yam
Amr8tottaram kas8a#yam
Gud8u#cya#di kas8a#yam
Nimba#di kas8a#yam
S$on8ita#mr8tam kas8a#yam Cu#r8n8am
Katakakadira#di kas8a#yam (Toya kalpana - For Diabetes) Sudars$anam
Tr8phala cu#r8n8am
Gulika
Kais$ora guggulu
S$iva gulika
Kr8mighna ghana vat8i
Vis8a vilva#di gulika

Lehyam
Ma#n8ibhadra gud8am (Very minimal dosage)
Ar8s8t8a
Vidangarishtam
Rasa ous8ada
A#rogyavardini vat8i
Mr8ga#n*ka rasa (Ref: Vaidya Chintha#mani)
 VIS8A VILVA#DI GULIKA (KRIYA# KAUMUDI)
Ingredients
Bilva#
Tulasi
Karan)ja
Tagara
Devada#ru
Mari#ca
Da#ruharidra
Aja#mu#tra
Hari#taki
Vibhi#taki Vis8a vilva#di gulika – Da#rvi#kara vis8a cikitsa
A#malaki Kas8a#ya tikta rasa

$
Sun8t8i Vis8ahara

Pippali S$ophahara

Haridra# Raktados8ahara

Pa#t8ha Su#lahara

Ni#lini Hr8dya

I#s8vari (50%) Vran8aropan8a

Dose :
Kas8a#yam – 50 ml – 50 ml – 50 ml on empty stomach
Gulika – 2-2-2 after food
Lehyam – 20 gm at bed time
Ar8s8t8am – 20 ml with water thrice daily after food

U#rdvajatru vises8a kriya#

Nasya – Va#sa# svarasa, Dron8apus8pi svarasa
Kavala- Gan8d8u#s8a – Tr8phala kas8a#ya
* Dhu#mapa#na - Mu#rdha virecana – Apara#jita (S$veta),
Jyotis8mati, Harita#lam, Manas$ila, Agaru (Ch.Su- 5/26)
* Note:
• This should be used by the assessment and supervision of an A#yurveda Vaidya
• Harita#la and Manas$ila should be used with care
• If hypoxia is present, Dhu#mapa#na is contraindicated
12
 MUCOR MYCOSIS IN A#YURVEDA - Stage II

Madhusnuhi Rasa#yanam
Gandhaka Rasa#yanam
Svar8n8ama#lini Vasanta Rasa
Maha#tikataka Ghr8tam
Guggulu Tikataka Ghr8tam
Ghr8tam should be given in the appropriate condition (Later phase of
recovery stage)

KOS8A#TAKYA#DI YAVA#GU
(A.H.U.35/21-23) Vis8apratis8eta adhya#ya
Mûˆ¬î «ð£‚°‹ è…C
Ingredients
Kos8a#taki (d˜‚°)
Citraka (ªè£´«õL)
Pa#t8a (õ†ìF¼ŠH)
Arka (⼂°)
Amr8ta (Y‰F™)
Abhaya (贂裌)
S$elu (ïÁML)
S$iri#s8a (õ£¬è)
Kin8ihi (õ£½À¬õ)
Haridra (ñ…êœ)
Da#ruharidra (ñóñ…êœ)
Punarn8avadvayam (Í‚Aó†¬ì, ê£ó¬í)
Tr8kat8u (²‚° I÷° FŠHL)
Br8hati (è‡ìƒèˆFK)
Kan8t8aka#ri (ºœÀ‚èˆFK)
Sa#riva# dvayam (ï¡ù£K, ªð¼ï¡ù£K)
Bala# (CŸø£º†®)
Ks8audra (Svarn8ama#ks8ikam) (ªð£¡QI¬÷)
A gruel made with the above said kas8a#ya, added with honey and ghee is to be taken
 PATHYA (DIET)
Avoid:
Urad dal
Sesame seed / oil
Dairy products
Jaggery
Sour foods
Newly harvested rice
Non vegetarian food

APARA#JITHA DHU#PAM
(A.H.Chi. 1/163-165)
Preventive & precautionary
Ingredients
Guggulu
Trun8a
Vaca#
Sarja
Nimba#
Arka
Agaru
Devada#ru
Phalas$ruti
Jvara#n sarva#n vya#pohati,
Vis8es8a#t vis8ama#n,
A#gantu and
Anubandhaja jvara

* Note : Dhu#pam should be used carefully in a patient with respiratory distress

The clinical study data will be provided later

14
Dr. Y. Mahadeva Iyer’s Sri Sarada Ayurvedic Hospital
Derisanamacope, Azhagiapandiapuram Post
Kanyakumari Dist - 629851
Tamilnadu
Phone: 04652 282239 / 282449 / 97516 91516
E-mail: [email protected]
www.saradaayurveda.com