India sees rise in deadly ‘black fungus’ cases amid virus surge
EXPERTS SAY DISEASE LINKED TO UNCONTROLLED DIABETES
A GROWING number of current and recovered Covid-19 patients in India are contracting a deadly and rare fungal infection, doctors said on Monday (10) as the vast nation battles to contain a massive outbreak of virus cases.
The world’s second most populous nation reported nearly 329,942 coronavirus infections to take the overall number of cases to above 23 million, and 3,876 new deaths, as Eastern Eye went to press on Tuesday (11).
Experts warn that the actual number of cases and fatalities could be much higher.
Mucormycosis, dubbed “black fungus” by doctors in India, is usually most aggressive in patients whose immune systems are weakened by other infections.
The state-run Indian Council of Medical Research (ICMR) said at the weekend that doctors treating Covid-19 patients, diabetics and those with compromised immune systems should watch for early symptoms, including sinus pain or nasal blockage on one side of the face, one-sided headache, swelling or numbness, toothache and loosening of teeth.
“Mucormycosis – if uncared for – may turn fatal,” ICMR, the scientific agency leading the government’s response, said in a treatment chart released on Twitter.
Covid-19 sufferers more susceptible to contracting the fungal infection include those with uncontrolled diabetes, those who used steroids during their virus treatment, and those who had prolonged stays in hospital ICUs, the ICMR added.
Treatment involves surgically removing all dead and infected tissue and administering a course of anti-fungal therapy. The disease, which can lead to blackening or discolouration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood, is strongly linked to diabetes. And diabetes can in turn be exacerbated by steroids such as dexamethasone, used to treat severe Covid-19.
“There have been cases reported in several other countries – including the
UK, US, France, Austria, Brazil and Mexico, but the volume is much bigger in India,” said David Denning, a professor at Manchester University and an expert at the Global Action Fund for Fungal Infections (GAFFI) charity.
“And one of the reasons is lots and lots of diabetes, and lots of poorly controlled diabetes,” he added.
India has not published national data on mucormycosis, but said there is no major outbreak. Medical experts said they had seen a rise in cases in India in recent weeks while media reports have pointed to cases in Maharashtra and its capital Mumbai, and Gujarat.
In Maharashtra, up to 300 cases have been detected, said Khusrav Bajan, a consultant at Mumbai’s PD Hinduja National Hospital and a member of the state’s Covid-19 taskforce.
Some 300 cases have been reported so far in four cities in Gujarat, including its largest Ahmedabad, according to data
from state-run hospitals. The state ordered government hospitals to set up separate treatment wards for patients infected with “black fungus” amid the rise in cases.
Aparna Mukherjee, who is a scientist at ICMR, said: “It is not something to panic about, but you have to be aware of when to seek consultation.”
“The cases of mucormycosis infection in Covid-19 patients post-recovery is nearly four to five times than those reported before the pandemic,” Ahmedabad-based infectious diseases specialist Atul Patel, a member of the state’s Covid-19 taskforce, said.
Yogesh Dabholkar, an ear, nose and throat specialist at Mumbai’s DY Patil Hospital, said the drugs used to treat those infected with the fungus were expensive. One of the treatment drugs was also running short in government hospitals due to the sudden spike, he added.
“The mortality rate is very high... Even the few that recover, only recover with extensive and aggressive surgery,” Bajan
said. “This is a fast-moving infection. It can grow within two weeks... It’s a Catch-22, coming out of a virus and getting into a fungal infection. It’s really bad.”
Arunaloke Chakrabarti, head of the Center of Advanced Research in Medical Mycology in Chandigarh and an adviser to GAFFI, said that even before Covid-19, mucormycosis was more common in India than in most countries, “partly because of the millions who have diabetes”.
He said that serious cases might require specific antifungal therapy and several operations.
“Previously if I saw one patient a year, I now see about one a week,” said Nishant Kumar, a consultant ophthalmologist at Hinduja hospital in Mumbai, noting the potential for contamination of oxygen pipes and humidifiers in hospitals.
Denning called it a “triple whammy”. “You’ve got a high rate of mucormycosis, you’ve got a lot of steroids – maybe too much – being used, and then you’ve got diabetes which is not being well controlled or managed.”