Struggle of mucormycosis patients continues
MUMBAI: Bhaidas Mali, 35, a police sub-inspector with the Maharashtra police is currently waiting to undergo plastic surgery to reconstruct his palate at Global Hospital in Parel. Amid the Covid-19 pandemic’s second wave last year, Mali was diagnosed with mucormycosis – commonly known as black fungal infection – within a month of recovering from Covid-19 in March 2021.
Mucormycosis is caused by a group of moulds called mucormycetes that are present in the environment. These fungi attack those battling illnesses like Covid-19, when the body’s immunity is at its lowest. The infection invades facial bones and eye orbit and even reaches the brain. The black fungus can lead to visual loss, severe disfigurement and also death.
“Post diagnosis, I underwent three surgeries to remove the infection. A major part of my palate was removed along with nine teeth,” said the Nashik resident, who spent three-and-ahalf months in three hospitals across Maharashtra.
Mali, who resumed work in August, now uses an artificial palate and has spent ₹63 lakh so far on his treatment.
In May 2021, the Ministry of Health and Family Welfare (MoHFW) declared mucormycosis as a ‘notifiable disease’ under the Epidemic Diseases Act, 1897, due to the resurgence of Covid cases.
Since May 2021, the state has recorded 10,871 mucormycosis cases -- 976 in Mumbai -- of which 9,112 patients have been cured, 16 are undergoing treatment and 330 died due to the infection. Between January 2022 and March 2022, the state reported only 37 mucormycosis cases amid the third wave.
But for survivors like Mali, who are awaiting corrective surgeries, the struggle is far from over.
Nerul resident Deepak Ayare, 55, lost his left eye and palate to the infection in 2021. A non-diabetic, Ayare’s sugar levels shot up when he was infected with Covid-19. He was subsequently diagnosed with mucormycosis. Seven months after the surgery, Ayare got a temporary palate in November and subsequently resumed work.
“For those seven months, I was on a liquid diet and only my wife could understand what I was speaking. I would otherwise communicate with sign language or write,” recalled Ayare, who is the vice-president of a bank.
Experts’ view
With the sudden loss of vision coupled with disfigurement, a psychiatrist from the city’s largest civic-run KEM Hospital, Parel, said most of the patients displayed sleep issues, anxiety and depression, and required counselling. Given the surging number of mucormycosis cases in Covid patients, the state government set up a task force for mucormycosis.
Doctors said apart from the unscrupulous use of steroids, non-distilled water used to generate medical oxygen given to patients was among the reasons for the sudden spike in cases.
Dr Kedar Toraskar, critical care specialist, Wockhardt Hospital and state Covid-19 task force member, said apart from conventional risk factors like diabetes and diabetic ketoacidosis and immunocompromised state, Covid-19 virus itself could be an independent risk factor for developing mucormycosis. “Mucor is iron-friendly and we see a lot of Covid-19 patients having high ferritin levels. This may be one of the reasons for this unique relationship that will have to be validated with studies,” he said.
Dr Milind Navlakhe, ENT surgeon, Global hospital, Parel, who had analysed his cases said, “Some patients were at home, not given much oxygen and still got mucormycosis. Some patients didn’t receive steroids and still caught the infection. The only common factor that we saw in our data analysis was all of them had high blood sugar levels at some point,” said Dr Navlakhe.
Dr Shashikant Mhashal, associate professor, ENT, RN Cooper Hospital, who has operated on 55 patients to date, said, “The infection leads to death of body tissue. Surgical debridement, which involves removing the part affected by mucor, is the only solution. We removed 14 palates and four eyeballs in 55 mucormycosis patients. Early diagnosis of mucormycosis plays a key role in saving life and disfigurement.”
Ghulam Ali Shaikh (39), a small-time businessman from Goregaon, is one of the two mucormycosis cases in Mumbai reported so far this year. Shaikh who has lost his left eye and palate is presently recuperating at home. “He is unable to talk properly since the palate is not there. We plan to get him a temporary one within two weeks. Doctors said he will take another six months to get back to normal life,” said Yogita Sutar, his partner.
While doctors aren’t sure if Covid-19 triggered mucormycosis in Shaikh’s case, Sutar said he had Covid-19 symptoms a few days before hospitalisation. “We came to know of his uncontrolled sugar levels post hospitalisation. He was otherwise healthy,” said Sutar.
Meanwhile, BMC has asked Seven-Hills Hospital to investigate mucormycosis cases. BMC health department said the study is aimed at understanding the interconnection between mucormycosis and Covid-19.
DOCTORS SAID UNSCRUPULOUS USE OF STEROIDS, NON-DISTILLED WATER USED TO GENERATE MEDICAL OXYGEN GIVEN TO PATIENTS LED TO SPIKE