A typically rare fungal infection called mucormycosis has surged in India recently, primarily affecting people recovering from COVID-19. After a crushing second wave of Covid-19, when the country is persistently seeing around 350,000 new infections a day, has led to a massive increase in cases that require strong medication. Now, the long-term effects of such drugs are leading to cases of a rare fungal infection, which can even prove fatal in some instances. Mucormycosis, colloquially known as black fungus, is an infection from the mucormycetes group of fungi. It is abundantly found in natural environments, especially in soil. Though rare, this infection has been around for decades, but only impacts those with health conditions and significantly weakened immune systems because of the use of steroids.
The rising cases of mucormycosis in Covid-19 patients are prevalent largely because of the increased use of steroids like dexamethasone, especially among diabetics. Not everyone is predisposed to the black fungus disease, but unchecked and unsupervised use of steroid therapies can often make matters worse even for non-risk patients.
AIIMS Director Randeep Guleria on Saturday said that mucormycosis, also known as ‘black fungus,’ is not any new infection but the number of cases has increased due to Covid-19.
AIIMS Director Randeep Guleria also warned against the spread of mucormycosis and recommended that with COVID-19 cases increasing, it’s of paramount importance that protocols of infection control practices are followed at hospitals. He said that misuse of steroids is a major cause behind the infection (Mucormycosis). Chances of fungal infection increase in the patients who are diabetic, COVID positive and are taking steroids. To prevent it, we should stop the misuse of steroids.
He said, “This disease (Mucormycosis) can affect the face, infecting nose, orbit of eye, or brain, which can cause even vision loss. It can also spread to the lung.”
Dr Guleria further added, “As COVID-19 cases are increasing, it’s of paramount importance that we follow protocols of infection control practices at hospitals. It is been seen that secondary infections — fungal & bacterial — are causing more mortality”
Dr Suresh Kumar, MD LNJP Hospital said, “Steroid use must be reduced. If given to patient with O2 level over 90, black fungus is a possible side-effect. Early diagnosis, CT scan of face would detect this infection. Antifungal drug Amphotericin being used for treatment.”
He also said, “Overuse, misuse & rampant use of steroids in COVID patients causes black fungus, also known as Mucormycosis. We have 4 patients here who also are diabetic. Quite often a patient dies due to black fungus instead of COVID-19.”
According to Monalisa Sahu, an infectious diseases doctor at Hyderabad-based Yashoda Hospital, says there is a subset of people that is particularly susceptible to this disease. This includes Covid-19 patients with:
- Uncontrolled diabetes and diabetic ketoacidosis (a complication of diabetes where the body produces harmful acids called ketones);
- Those who have received high doses of intravenous or oral steroids for prolonged periods;
- And those who have received immunomodulators (drugs used in diseases like cancer to modify the immune system’s response)
A few symptoms to detect Mucormycosis are as under: Mucormycosis can often have early warning signs that seem a lot like a regular sinusitis infection. Doctors recommend that because mucormycosis is an aggressive infection and can spread in one’s body rapidly, patients with any of these symptoms should immediately seek medical attention.
- Rhino-orbito-cerebral mucormycosis (of the nose, eye, and skull area):Nasal blockage or congestion; blackish or bloody nasal discharge; facial pain, numbness, or swelling; headache or pain in the eyes and orbit; toothache, loosening of tooth, or jaw involvement; blurring or double vision with pain; tingling sensation on the face; fever, and blackish skin lesions.
- Pulmonary mucormycosis (involving the chest):Fever, cough, chest pain, blood in sputum after cough, worsening respiratory symptoms.
Mucormycosis cases can appear as early as eight to 10 days after Covid-19 detection, to as late as 60 days after it. The two- to six-week period after Covid-19 is detected is the most crucial. Dr. Sahu recommends that to treat mucormycosis a general physician may not be enough. She said, “A multi-disciplinary approach is needed in such cases. This could include specialised surgeons like a neurosurgeon, ENT surgeon, cardio-thoracic and vascular surgeon, and maxillofacial surgeon, and medicine specialists such as an Infectious diseases physician,” In an advisory released on May 9, the Centre said mucormycosis may turn fatal if uncared for. It also said the fungal infection mainly affects people who are on medication that reduces their ability to fight environmental pathogens.
