At a time when India’s healthcare infrastructure has already been stretched to its limit, the clouds of a new trouble loom over the country. Recently, a rare fungal disease, called the ‘black fungus’ or mucormycosis, has been reported in some Covid-hit patients in many parts of the country. The disease is causing blindness in some cases. If left uncared for, mucormycosis may also turn fatal, stated an advisory released by the ICMR and Union Health Ministry.
In pre-pandemic times, there used to 24.7-89 cases of mucormycosis per year at a single tertiary-care hospital. This number has now increased to over 2,000 cases in the past 2-3 months in Maharashtra, one of the worst hit by Covid as well as mucormycosis.
Also known as ‘black fungus’, mucormycosis is a deadly fungal disease caused by mucormycetes, a group of molds belonging to the order Mucorales. Mucormycetes, the fungal group responsible for this infection, are typically found everywhere in the environment, mostly in soil or dead and decaying organic waste such as animal faeces, dead leaves and composts. These are also present in the air in the form of extremely small spores. Hot and humid conditions favour their growth.
Inhalation of these fungal spores floating in the air is the most common cause of this infection. Another way this deadly fungus can enter our body is by direct inoculation through cuts, burns or surgical wounds. Looking at the current situation in our hospitals, it is probable that congested wards and poor ventilation are exposing patients with already low immunity to this deadly disease.
A video report by Reuters has directly linked the increasing cases of ‘black fungus’ in Gujarat to the use of cow dung and urine in Covid therapy. Although there’s no proof to this link, doctors across the globe believe it’s quite probable. People have been advised by the medical field to not fall for these myths. Such foolish acts not only risk patients, but also add to the worries of the already-overworked doctors.
Mucormycosis is a rare disease that doesn’t affect healthy people, but recently, it has been detected in many Covid patients, particularly with a diabetic condition. According to some health experts, this disease mostly targets immunocompromised people. This mostly includes those who have recently had an organ/stem cell transplant or are undergoing prolonged treatment, especially therapies involving use of immunosuppressant drugs.
Speaking at a clinical excellence programme, AIIMS Chief Dr Guleria said that data suggested that more than 90% of mucormycosis patients are diabetic. Unlike last year, this time, even active Covid patients are contracting this disease, he said. He urged doctors to use steroids and immunosuppressants judiciously in their Covid treatment and regularly monitor the blood sugar level of their patients. The Health Ministry has already warned against prolonged use of steroids in Covid patients, as it puts them at high risk of the fungal infection.
The ‘black fungus’ is known to have multiple forms, each attacking different parts of the body. Thus, its symptoms are also wide-ranging and include chest pain, progressive difficulty in breathing, formation of lesions on the skin, eschars, ulcers, headache, fever, formation of black patches in and around the nose, lethargy, eye-pain, blurry vision and further worsening of these.
In a press conference, Dr Harsh Vardhan, Union Health Minister, warned recovered patients to be on guard against the fungus and not overlook any sign matching the symptoms mentioned in the official advisory. Contact a doctor immediately if you’re witnessing such symptoms.
No, mucormycosis is not contagious. It cannot be transmitted from one person to another. After the trauma that the coronavirus has brought us, it is only natural to fear that a disease is contagious.
Presently, there is no vaccine for this disease. The only cure we have is antifungal medication and surgery. Depending on the type and severity of a case, doctors decide what discipline to follow. In mild cases, administration of antifungals such as amphotericin B, along with some immunity boosting supplements, takes care of the patient, while in severe patients doctors, might have no choice but to perform surgical debridement of the affected tissues or organ to save the patient’s life. As this infection grows rapidly, early diagnosis becomes crucial for successful treatment.
“Team approach works best,” said the ICMR as it plans to form dedicated groups of dentists, ENT specialists, microbiologists, internal medicine experts, surgeons and other medical experts to fight the ‘black fungus’.
It’s difficult to avoid mucormycetes as these are present almost everywhere, but if you are a healthy person, then you shouldn’t worry about it as these are opportunistic pathogens looking for a weak host. In the advisory, the Ministry has given instructions to monitor blood sugar levels of both diabetic and non-diabetic Covid patients. It has also emphasised on the need to judiciously use steroids as well as sterile water in humidifiers for patients undergoing oxygen therapy.
If your immunity is low or you’ve recently had a surgery or transplant, then you should be extra careful. Take immunity boosters. Avoid going near unhygienic or dusty places such as construction sites, excavation sites, etc. If you can’t avoid it, then do not pull your mask down when near these sites. Wash your hands regularly and dry them well. Avoid any direct contact with soil. Keep your house and workplace clean and hygienic. Remember, prevention is always better than cure.
To read more about mucormycosis, check out this article by the CDC.