What is mucormycosis, the “black fungus” disease impacting Covid-19 patients in India?

What is mucormycosis, the “black fungus” disease impacting Covid-19 patients in India?

India’s Covid-19 pandemic is about to get much more complicated.

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.

While it is not classified as an outbreak yet, the Indian Council for Medical Research, the government’s main research organisation, has released a set of guidelines to spot and treat mucormycosis.

ICMR

The ICMR’s guideline on how to detect and treat mucormycosis or “black fungus.”

When caught early, it is entirely treatable.

Who is at risk for mucormycosis?

According to Monalisa Sahu, an infectious diseases doctor at Hyderabad-based Yashoda Hospitals, 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)

Symptoms of black fungal disease

Mucormycosis can often have early warning signs that seem a lot like a regular sinusitis infection. For this reason, Sahu says those in the at-risk category, and especially those recovering from Covid-19, should keep an out for:

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.

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.

Where to seek medical attention

Sahu recommends that an aggressive black fungal infection needs an aggressive medical approach. For this, a general physician may not be enough. “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,” she says.

She adds that 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, Sahu adds.

At the onset of even a single symptom, patients should consider it a medical emergency.

How is mucormycosis treated?

“All cases of mucormycosis should be treated as a medical and surgical emergency,” Sahu says. Sometimes, a case may need surgical intervention to remove the diseased tissue and stop its further spread. In some cases, anti-fungal drugs will also need to be given to patients intravenously, which may mean hospitalisation.

These drug treatments, either orally or via injections, are generally for a period of six weeks and can go on for up to six months. In India, each of these anti-fungal injections can cost around Rs7,000 (approximately $100), and a patient needs up to nine of these a day. A minimum three-week course could cost as much as Rs13 lakh, which is over 10 times the annual median wage in India.

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