New Delhi: Black Fungus or mucormycosis, a rare fungal infection with a mortality rate of 50 percent, is being reported from various parts of India among COVID recovered patients.

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The disease is caused by a group of moulds known as mucormycetes, which are naturally present in the environment. 


Black Fungus most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. The illness can cause blindness, organ failure, brain stroke and can be fatal.

“Though there is no record of the official number of Black Fungus cases in India, estimation of fungal burden of the country, using computational models by international health experts, predict around 1750 to 2500 cases of mucormycosis daily in india. This is just a predictive model so the actual number may be higher,” says Dr Mubasheer Ali, Senior Internal Medicine Consultant, Apollo Tele Health.

Dr Mubasheer shares the two main reasons why COVID recovered patients are getting infected with mucormycosis. “There are mainly two reasons COVID-19 patients are getting affected with mucormycosis; One is the presence of comorbidities such as uncontrolled diabetes mellitus, chronic obstructive pulmonary disease etc; and the second one is if these COVID patients are treated with corticosteroids,immunomodulators,mechanical ventilation and long standing oxygen therapy.”

Explaining how the use of steroids while treating COVID-19 put people at higher risk of getting  Black Fungus, Dr Bhavika Verma Bhatt, ENT Surgeon and Medical Consultant - ENTOD International shares, “Steroids reduce inflammation in the lungs of COVID-19 patients and appear to help stop some of the damage that can happen when the body's immune system goes into overdrive to fight off coronavirus. However, the steroids also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic COVID-19 patients. It's thought that this drop in immunity could be triggering these cases of mucormycosis.”

She further adds, “Black Fungus generally affects COVID-19 recovered patients who have other comorbidities like diabetes, kidney or heart failure, cancer as well as patients who are on steroids or have had a transplant. However, it is most common in diabetic patients, said the Centers for Disease Control and Prevention (CDC) of the United States.”

Common symptoms that COVID recovered patients should look out for Black Fungus are swelling in the face, pain and numbness, unusual (bloody or black-brown) discharge from the nose, swollen eyes, nasal or sinus congestion or black lesions on nasal bridge or upper inside of mouth.  An early medical intervention can stop spread of the infection.
 
“Mucormycosis, if left undiagnosed or untreated, may result in blindness, removal of the nose, jaw-bone or even death,” says Dr Bhavika.

However the most worrisome part of the Black Fungus is the exorbitant cost of its treatment, which a large chunk of our population cannot afford.

“Anti fungal medication is costly. One anti-fungal vial of amphotericin b of 50 mg costs around Rs 5000 to 8000 and according to the dosage, a minimum 5mg has to be given i.e 5 mg per kg body weight. So a 50 kg patient needs 250 mg that comes to Rs 40,000 for eight vials. Apart from this another anti-fungal Posaconazole costs Rs 4000 for a daily dose and injectable Isavuconazole costs Rs 12,000 which as per the schedule on first day 3 injections are given and the next day onwards 2 per day,” reveals Dr Mubasheer.

The Indian state of Gujarat has reported over 100 Black Fungus cases and Maharashtra has announced free treatment for the disease. However, the state may cap the cost of medication.