‘Black fungus’ now a concern in India: Govt
Health ministry tells states to announce mucormycosis as a notifiable disease under the Epidemic Diseases Act
NEW DELHI: The Centre has ordered tighter surveillance of a rare fungal disease hitting Covid-19 patients, piling pressure on hospitals struggling with the world’s highest number of daily infections of the coronavirus.
The Union health ministry on Thursday asked the states and the Union territories (UTs) to announce mucormycosis, commonly known as the black fungus disease, as a notifiable disease under the Epidemic Diseases Act of 1897, stating that the infection is leading to prolonged morbidity and mortality amongst Covid-19 patients.
Mucormycosis usually infects people whose immune system has been compromised, causing blackening or discolouration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood.
Doctors believe that the use of steroids to treat severe Covid-19 could be causing the rash of cases because those drugs reduce immunity and push up sugar levels.
The ministry, in a letter, said mucormycosis has emerged as a new challenge in many states amongst Covid-19 patients on steroid therapy and those with pre-existing diabetes. “This fungal infection is leading to prolonged morbidity and mortality amongst COVID 19 patients,” the health ministry’s joint secretary Lav Agarwal said in the letter.
The treatment of the fungal infection requires multidisciplinary approach consisting of eye surgeons, ENT specialists, general surgeon, neurosurgeon and dental maxillo facial surgeon, among others, and institution of Amphotericin-B injection as an antifungal medicine.
“You are requested to make mucormycosis a notifiable disease under the Epidemic Diseases Act, 1897, wherein all government and private health facilities, medical colleges will follow guidelines for screening, diagnosis, management of mucormycosis, issued by the Ministry of Health and Family Welfare (Gol) and the Indian Council of Medical Research (ICMR).
“And, make it mandatory for all these facilities to report all suspected and confirmed cases to health department through district-level chief medical officer and subsequently to Integrated Disease Surveillance Programme (IDSP) surveillance system,” Agarwal said in the letter.
Normally a rare disease, mucormycosis has been reported in thousands of Covid-19 patients across the country. With many of them succumbing to it, it has already been declared an epidemic by states such as Rajasthan. Black fungus cases have shown a mortality rate as high as 50%. Maharashtra alone has reported at least 50 deaths. States such as Madhya Pradesh have also reported fatalities.
On Thursday, Delhi chief minister Arvind Kejriwal said he has directed three government-run hospitals in the national capital to set up dedicated centres for Covid-19 linked black fungus cases while promising to ensure adequate supply of medicines needed to treat the disease. He also pledged awareness campaigns about the disease.
Hospitals have reported a shortage of antifungal medicines needed to treat mucormycosis as the number of such cases has increased. At least 185 patients were undergoing treatment for black fungus at seven Delhi hospitals.
The condition may be reaching epidemic proportions currently because of Covid-19 but mucormycosis was not unheard of in India earlier. Due to the lack of population-level data, its exact burden is unknown but it a rare condition, according to research papers on the disease and critical care experts.
“I cannot talk about disease incidence as such, but in our clinical life, we would see a maximum of five to seven such patients in the intensive care units. It was rare,” said Dr
Anjan Trikha, professor, department of anaesthesia, critical care and pain medicine, All India Institute of Medical Sciences (AIIMS), Delhi.
The incidence seems to have grown last year amid the Covid-19 pandemic.
“The black fungus infections went up 2.5 times last year between September and December across 16 centres in the country,” Arunaloke Chakrabarti, head of the department of medical microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh told HT earlier.
Chakrabarti is a part of the Fungal Infection Study Forum and is one of the members who drafted the government advisory on mucormycosis management.
“We did a study across 16 centres between September and December last year which showed that the infection had increased 2.5 times then. It is likely to go up further this time; we are planning to conduct another study.”
In its advisory this week, the health ministry said mucormycosis mainly affects people on medication for other health problems that reduce their ability to fight environmental pathogens. It has not yet been established whether the virus that causes Covid-19 is directly responsible for growing cases. But clinicians also say several factors found in Covid-19 patients could lead to the secondary infection.
“Mucormycosis needs fertile soil to grow, and high blood glucose levels, lack of oxygen, acidosis and suppressed immunity contribute towards the growth. There is a high probability of all these factors in Covid-19 patients which is, perhaps, leading to an increase in [black fungus] cases,” said Dr Ambrish Mithal, chairman, department of endocrinology and diabetes, Max Healthcare.
Reaching hospital late in most cases could be leading to deaths.
“There are not too many drugs available to treat the condition, and in India, one of the major problems is patients reporting late to the hospital which tends to alter the treatment outcome. But the reason for fungus becoming pathological and growing in various parts of the body is compromised immunity [people on high dose steroids for a prolonged period] and uncontrolled diabetes,” said Trikha.