NEW DELHI: Among the second wave of the coronavirus, reports of a rare fungal infection among the COVID-19 patients in India have come to the fore now. This rare fungal infection is being referred to as ‘Black fungus’ or ‘mucormycosis’ in medical parlance.
It is caused by a fungus named mucor, which is found on wet surfaces. Cases of mucormycosis are rapidly rising among COVID-19 survivors, causing blindness or serious illness and even death in some cases, health officials have warned.
A large number of mucormycosis patients who have recovered from the COVID-19 infection have been found in Maharashtra and Gujarat. Several of them are suffering from blindness.
In Maharashtra, at least eight COVID-19 survivors have died due to mucormycosis while 200 others are being treated, said Dr Tatyarao Lahane, who heads the Directorate of Medical Education and Research of the state government.
According to Dr Lahane, "They survived COVID-19 but the fungal infection attacked their weakened immune system."
How Black Fungus infects a COVID-19 patient
This disease is not new, but it is rising among COVID-19 patients in India because the excessive use of steroids elevates sugar levels and some medicines suppress the immunity of these patients leading to loss of vision and death in some cases. The Black Fungus infects a COVID-19 patient easily. If it reaches the brain, it can prove fatal, says Dr Lahane.
Who is more vulnerable to Black Fungus?
The `black fungus', is present in the environment, but those with suppressed immunity or co-morbidities are more vulnerable to its infection, according to the doctors.To a large extent, it is happening to people who have diabetes. It is very uncommon in those who are not diabetic.
What are the common symptoms of mucormycosis?
Symptoms of mucormycosis include pain and redness around the eyes and nose, fever, headache, coughing, shortness of breath, bloody vomits and altered mental status, the advisory stated.
How it can be treated?
This infection can be treated via intravenous (IV) medication or through surgery. A patient infected by Black Fungus generally needs a type of injection for 21 days. The basic cost of this injection is around Rs 9,000 per day. During the first phase of the COVID-19 pandemic, the fungal infection typically came to light a couple of weeks after patients were discharged, Dr Hetal Marfatia, professor and head of the ENT department at the government-run KEM hospital in Mumbai. Niti Aayog Member (Health) V K Paul had on Friday said that mucormycosis cases were being found in patients with COVID-19.
VK Paul said, "When a patient is on oxygen support, it should be ensured that water does not leak from the humidifier (to prevent the growth of the fungus)." He also called for "a rational usage" of steroids and medicines such as Tocilizumab to treat COVID-19 patients.
What does the ICMR advisory say
In an advisory prepared by the Union Health Ministry and ICMR which is evidence-based called for screening, diagnosis and management of the disease. It stated that it may turn fatal if not cared for, the government said mucormycosis is a fungal infection that mainly affects people who are on medication that reduces their ability to fight environmental pathogens.
"Mucormycosis, if uncared for, may turn fatal. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air," the advisory stated.
— ICMR (@ICMRDELHI) May 9, 2021
* Control hyperglycemia
* Monitor blood glucose level post-COVID-19 discharge and also in diabetics
* Use steroid judiciously – correct timing, correct dose and duration
* Use clean, sterile water for humidifiers during oxygen therapy
* Use antibiotics/antifungals judiciously
* Do not miss warning signs and symptoms
* Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
* Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology
* Do not lose crucial time to initiate treatment for mucormycosis
Medical treatment includes installing peripherally inserted central catheter, maintaining adequate systemic hydration, infusion of normal saline intravenously before Amphotericin B infusion and anti-fungal therapy for at least six weeks besides monitoring the patient clinically with radio imaging for response and to detect disease progression, it said.