Smack in the middle of the coronavirus pandemic, a fungal infection called Mucormycosis or black fungus, is being reported among COVID-19 patients, either during or post-recovery.
Mucormycosis is not a new disease. The infection was reported even before the pandemic. The difference is that the number of people affected by it was way lower back then. Presently, most of the instances of black fungus are cases of Coronavirus Disease Associated Mucormycosis (CAM).
Dr Randeep Guleria, Director of AIIMS, gave out some details about it during a press conference last week.
“Earlier, this infection was commonly spotted in individuals suffering from Diabetes Mellitus, a condition where one’s blood sugar (glucose) levels are abnormally high. Cancer patients undergoing chemotherapy, those who have had a transplant, and people taking immunosuppressants (medications that weaken the immune system) also used to get it. But now, due to coronavirus and its treatment, there is an increase in the number of cases. Several states have reported more than 400 to 500 instances, all among COVID patients,” Dr. Guleria said.
The present scenario
While states like Maharashtra and Gujarat have surpassed 1,000 cases, some have declared Mucormycosis an epidemic. Rajasthan was the first state in India to make the declaration under the Rajasthan Epidemic Act, 2020. It also announced free treatment for the disease in the state.
Ashok Gehlot, the Chief Minister of the state, recently made an announcement with regard to this, “Besides creating awareness among citizens about the symptoms and precautions related to black fungus, we have made arrangements for its free treatment across all districts of the state”.
Following the footsteps of Rajasthan, Maharashtra, Telangana, Tamil Nadu, Odisha, Gujarat, Bihar and the UT of Chandigarh also pronounced it to be an epidemic.
Causes and symptoms
Mucormycosis is a fungal infection, caused by a group of molds called mucormycetes. The infection attacks the body when it comes in contact with fungal spores in the environment. This can happen through air, water or even food. Black fungus can also develop on the skin, if it enters through a cut, scrape, burn or other injuries.
Though the infection is increasingly being detected in patients who are recovering or have recovered from COVID-19, it is imperative for people who have weaker immune systems or diabetes to be cautious.
As per an advisory issued by the Indian Council of Medical Research (ICMR), the following conditions in COVID-19 patients increases the risk of Mucormycosis -
- Uncontrolled diabetes
- Weakening of immune system due to use of steroids
- Prolonged stay at the hospital
- Comorbidities, post organ transplant and cancer
- Voriconazole therapy (used to treat serious fungal infections)
As per Dr Guleria, there are multiple symptoms to detect the initial stages of Mucormycosis. “One sided face swelling, headache, nasal or sinus congestion, black lesions on the nasal bridge, and fever are some of the common symptoms,” he noted in an official press release.
Though Mucormycosis starts off as a skin infection in the air pockets behind the forehead, nose, cheekbones, and in between the eyes and teeth, it later spreads to lungs and even to the brain. It causes blackening or discoloration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing of blood.
Why is Mucormycosis mainly affecting COVID-19 patients?
Under usual circumstances, an individual’s immune system is strong enough to fight against fungal infections. However, COVID-19 affects the immune system to a large extent. And, the treatment for coronavirus involves the intake of dexamethasone, which further suppresses response to the immune system.
More often than not, these medicines bring down the count of lymphocytes which protects the body against disease-causing pathogens (bacteria, viruses, and parasites) and causes lymphopenia. Hence, COVID-19 patients, especially those undergoing oxygen therapy, are at a greater risk of getting attacked by organisms like mucormycetes.
Dr Guleria says, “90 to 95 percent of patients who get infected with Mucormycosis are either diabetic and/or taking steroids. This infection is rarely seen otherwise.”
While anti-fungal treatment for four to six weeks is one of the most important procedures for individuals who contract the fungal infection, surgery is also an option, in certain cases.
When it comes to diabetic patients, maintaining good hygiene is imperative. And, the ones who use oxygen concentrators need to clean humidifiers regularly.
If the infection affects various parts of the body, a multi-disciplinary approach that involves removing the dead and infected tissue surgically is required.
In a letter sent out to the states, Lav Agarwal, Joint Secretary of the Health Ministry, mentioned about this integrative approach. He explained that it involves a collaborative effort from eye surgeons, ENT specialists, general surgeons, neurosurgeons and dental maxillofacial surgeons as well as a dosage of Amphotericin B as an anti-fungal medicine.
Measures to prevent the infection
In order to prevent black fungus, regular cleaning and replacement of humidifiers as well as sterilisation of normal saline within the humidifiers is necessary.
Steroids should be used only as per medical advice, specifically with respect to individuals affected by COVID-19 and diebetic patients.
Self-medication and over-dosage of steroids can be fatal.
Dr VK Paul, Member of the Niti Aayog and head of the Health, Nutrition and HRD verticals, has pointed out the adverse effects of inappropriate steroid usage.
As per an official press release by PIB, Dr. Paul says, “Steroids should never be administered in an early stage of contracting COVID-19. It should be taken only after the sixth day of infection. Patients should stick to the exact dosage of drugs. Rational use of medicines should be ensured to avoid side effects.”
Other than steroids, use of Tocilizumab, Itolizumab also suppresses the immune system. “When these drugs are not used appropriately, it increases the risk, because the immune system fails to fight the fungal infection.” he adds.
Edited by Roshni Shroff
Some resources and links to help you learn more about Mucormycosis -