29 ‘black fungus’ cases in AIIMS, Ganga Ram cause fear in Capital

MUCORMYCOSIS, ALSO KNOWN AS BLACK FUNGUS, HAS BEEN SEEN AMONG THOSE WHO HAVE UNCONTROLLED DIABETES

NEW DELHI: Hospitals are recording a spike in cases of mucormycosis, a potentially deadly fungal infection, as the surge in Covid-19 cases has led to several people being prescribed steroids and immunomodulators that leave some people vulnerable to other pathogens.

Mucormycosis, also known as black fungus, has been seen among those who have uncontrolled diabetes, whose immunity is compromised or those who are given excessive steroids or immune-modulating drugs such as tocilizumab, doctors said.

They added that, if left untreated, it’s fatality rate can be up to 80%. If not detected early, it can affect the orbit of the eyes and the mouth, resulting in people losing their vision or use of their jaw during debridement — the process of removing dead tissue from infections or wounds.

At least 10 patients suspected to have contracted mucormycosis are currently admitted to the All India Institute of Medical Sciences (AIIMS). Doctors said the centre used to see only two such cases a month previously.

“We have 10 patients admitted in the ENT department who, we suspect, have mucormycosis. Now, we are seeing reports of opportunistic infections like mucormycosis from Gujarat and other areas where it (tocilizumab) was used a lot. Many Covid-19 patients either have underlying diabetes or their blood sugar levels became uncontrollable because of the steroids given for treatment. Some of them receive medicines, such as tocilizumab and itolizumab, which further the aggressive decline in the immune system. All this leads to a very high chance of opportunistic infections,” said Dr Randeep Guleria, director of AIIMS, in a webinar.

Dr Alok Thakar, head of the ENT department at AIIMS, said, “We are seeing a surge over the last week or so. The last time we saw a surge in mucormycosis cases was when Covid-19 cases increased but this time, the number of cases is greater. Since last year, we are treating probably three to four patients a month and now, we are treating four patients a day at times. For the last three days, we have been getting four to five patients a day.”

He added: “It generally occurs a couple of weeks after the onset of Covid-19 infections. However, it is still rare even among Covid-19 patients ; very few who have recovered will get it.”

Thakar said people should maintain basic hygiene after recovering from Covid-19 to ensure that they do not get any infections, stay away from soil, and also regularly test their blood sugar levels.

Another 19 people with mucormycosis are admitted at Sir Ganga Ram Hospital, said Dr Ajay Swaroop, head of the ENT department at the hospital.

“Before Covid-19, I would have seen as many cases probably in five years. We get one patient with the fungal infection in three to four months; that too because we are a big tertiary care facility. Now, we are hearing of patients in other city hospitals who have contracted mucormycosis and who want to move in here for treatment.”

The sudden increase has also resulted in a shortage of antifungal medicines used for treating the infection. “The anti-fungal drugs are not freely available and there is a shortage because the demand has gone up,” said Dr Guleria.

Dr Swaroop said, “I don’t know the current situation about the drugs, it stands to reason that if 35 people need it instead of the usual five, there will be a shortage. The lypholised (freezedried) drug that is slightly better and less toxic to other organs was anyway difficult to get.”

Black fungus infection numbers went up 2.5 times last year between September and December across 16 centres in the country, said Dr Arunaloke Chakrabarti, head of the department of microbiology at Post Graduate Institute of Medical Education & Research, Chandigarh. He is part of the Fungal Infection Study Forum and is one of the members who drafted the government advisory on mucormycosis. “It is likely to go up further this time; we are planning to conduct another study,” he said.