A rare but deadly fungal infection has been detected among recovering and recovered patients of COVID 19 in some states of India. Cases of Mucormycosis, colloquially known as black fungus have been detected in Delhi, Maharashtra, Gujarat, Karnataka, and many others. Despite the absence of a significant outbreak, the national Covid-19 task force released an evidence-based advisory on the disease on Sunday.
What is the black fungus infection?
It is a dangerous infection, despite its rarity. Mucormycetes, a form of mold occurring naturally in the atmosphere, trigger it. Mucormycete spores can be found in soil, seeds, manure, and rotting fruits and vegetables. According to Dr. Akshay Nair, a Mumbai-based eye surgeon, "It is ubiquitous and found in soil and air and even in the nose and mucus of healthy people." Black fungus mainly affects those who are on medication that reduces their ability to fight environmental pathogens. If the infection is not treated, it can be fatal. After inhaling fungal spores from the air, it usually infects the sinuses or lungs of the patient. Mucormycetes may not usually pose a significant threat to people who have a strong immune system. However, mucormycosis cases have proved to be dangerous for COVID patients, some even needing emergency surgery.
Suspected cause in COVID 19 survivors
It is the belief of many doctors that black fungus, which usually has a mortality rate of 50%, maybe triggered by the use of steroids as a treatment for COVID-19. Steroids are used in Covid 19 patients to reduce inflammation of the lungs which prevents the damage caused by the Bodies immune system going into overdrive to fight Coronavirus. However, steroids are known to reduce immunity and increase blood sugar levels in both diabetic and non-diabetic COVID-19 patients. A decrease in immunity could be the trigger behind mucormycosis in a Covid 19 patient.
What happens when one contracts black fungus?
Pain and redness around the eyes or nose, with fever, headache, coughing, shortness of breath, bloody vomit, and altered mental status are all early signs of the deadly infection.
1. Sinusitis - nose obstruction or congestion, blackish or bloody nasal discharge
2. Local pressure on the cheek bone, one-sided facial pain, numbness, or swelling
3. Blackish discoloration over the bridge of nose/palate
4. Loosening of teeth, jaw involvement
5. Blurred or double vision with pain
How can black fungus in COVID 19 patients be treated?
Doctors usually treat mucormycosis with antifungals, but it may eventually require a surgical procedure. It is extremely important to control diabetes, reduce the consumption of steroids, and discontinue immunomodulating drugs.
It is essential to control hyperglycemia, monitor blood glucose levels after the discharge of Covid 19 patients and also in people who suffer from diabetes. Steroids must be used judicially – they must be given at the correct time for a correct duration and in modulating doses. Clean water must be used for humidifiers at the time of oxygen therapy.
How can black fungus in COVID 19 patients be prevented?
Regardless of it being an extremely rare condition some groups of people are more susceptible to it. Predispositions that patience might have are- uncontrolled diabetes mellitus, immunosuppression by steroids prolonged ICU stages, and comorbidities such as post-transplant/malignancy, voriconazole(is an antifungal medication used to treat a number of fungal infections) therapy.
One must ensure the use of masks if you are visiting a dusty construction site. Shoes, long trousers, long sleeve shirts, and gloves are a must while handling any type of soil, moss, or manual or. Personal hygiene should be maintained this can be done even with a scrub bath.
According to Dr. Rahul Baxi, a Mumbai-based diabetologist, one way to prevent the fungal infection was to ensure that Covid-19 patients were given the proper dose and length of steroids while in care and after recovery.
How often are Mucormycosis cases being detected?
A member of Niti Aayog, Dr. VK Paul, said at a media briefing that there was no major outbreak of black fungus and all reported cases were being monitored.
Dr. Tatyarao Lahane, head of the directorate of medical education and research, claims that black fungus cases are on the rise. Generally, It was only seen every few months in patients who did not have diabetes under control, according to Dr. Parikshit Gogate, consulting ophthalmologist at Ruby Hall Clinic, Pune. "But in the past 2 to 3 weeks, I have seen almost 25-30 of them, mostly in Ruby Hall, some in D Y Patil Hospital," he said.
According to Dr. Renuka Bradoo, head of the hospital's ENT wing, Mumbai's Sion Hospital has reported 24 cases in two months. 11 of the 24 have lost and I and six of them have died. In Bangalore, Dr. Raghuraj Hegde, Says that he has seen over 19 cases of mucormycosis in two weeks, most of whom were young patients. There is an increased severity and frequency in cases of this fungal infection during the second deadly wave of Covid 19. As compared to this the first wave saw only a few cases.
Patients that have been treated with steroids and other medications for Covid 19 to minimize inflammation are the most vulnerable to mucormycosis. Dr. Soman, one of the expert members who drafted the advisory as part of the national Covid-19 task force, said that efforts are being made to collect data for major studies being conducted by the Fungal Infections Study Forum and the Clinical Infectious Diseases Society.