Black Fungus Outbreak In India.

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Black Fungus is a fungal infection that results from COVID-19, that is why it is also called COVID-associated mucormycosis​1​. Black fungus is a type of mucormycosis. This fungal infection affects the nose, eyes and sometimes the brain. Humans catch the disease by inhaling fungus spores that float around in the air and in dust. These spores become trapped in the nasal passages and sinuses, where they cause sickness. The cases of black fungus are being seen in the recovering patients or recovered patients of COVID-19.

Key Point in the Article:

So, What Is Mucormycosis?

A Mucormycosis patient's eye.
Image Source: Wikipedia

Mucormycosis is a very rare infection. It is caused by mucor mould, which is widely found in soil, plants, manure, and decaying fruits and vegetables. “It’s present everywhere, in soil and air, and even in healthy people’s noses and mucus,” says Dr. Nair. (a doctor from Mumbai working in three hospitals) It affects the sinuses, the brain, and the lungs, and it can be deadly in diabetics or persons who are extremely immunocompromised, such as cancer patients or HIV/AIDS patients.

Who Are At Most Risk?

  • People who have a weak immune system are at risk, however, not everyone who comes into contact with the spores will get infected. “For most part, if you have a normal immune system, it’s mostly an asymptomatic, silent encounter,” says Tobias Hohl, chief of infectious disease service at Memorial Sloan Kettering Cancer Center in New York.
  • People with blood cancer who are receiving chemotherapy or those who have had a bone marrow transplant and are unable to develop neutrophils—a type of white blood cell that fights infection​2​.
  • Doctors believe that mucormycosis, which has a mortality rate of 50% is being triggered by the use of steroids which is becoming a life-saving treatment for severely affected patients of Coronavirus.

So, why are critically ill patients of Covid-19 being treated with steroids to save their lives?

That is because, Steroids appear to help reduce some of the damage that can occur when the body’s immune system goes into overdrive to fight the coronavirus and steroids help in reducing inflammation in the lungs. But they are also responsible for reducing immunity and raising blood sugar levels, in both diabetes and non-diabetic Covid-19 patients. This decrease of immunity is thought to be the cause of the mucormycosis outbreaks. “Diabetes lowers the body’s immune defenses, coronavirus exacerbates it, and then steroids which help fight Covid-19 act like fuel to the fire,” says Dr Nair.

Though the infection was still present before the outbreak of Coronavirus but now it’s something different. In April, there were approximately 40 people who were infected with the fungal infection. Many of them were diabetics who had recovered from Covid-19 at home. And eleven of them had to have an eye removed surgically and six of them died. Between December and February there have been 58 reposted cases of this infection. A similar story has been told by Dr Raghuraj Hegde, an eye surgeon in Bangalore, in the southern city of India. In the last two weeks, he has encountered 19 cases of mucormycosis, the majority of which are young individuals. “Some were so sick that we couldn’t even operate on them.” said, Dr. Renuka Bradoo.

What Are The Symptoms Of Black Fungus?

  • Symptoms include a stuffy and bleeding nose.
  • Eye swelling and pain, drooping eyelids, blurred vision,
  • And lastly, vision loss.
  • Around the nose, there could be black patches of skin.

How To Prevent Or Treat Black Fungus?

  • Wear mask if you are visiting a dusty place like a construction site​3​.
  • Wear gloves while handling soil, as it is present in soil too.
  • Do not hesitate to seek aggressive interventions.
  • Doctor says patients come to them after they have lost their vision and then the doctors have to remove the eye or both the eyes to prevent the infection from reaching the brain, in extreme cases doctors have to remove the jaw bone of a severely infected person in order to stop the disease from spreading. So in order to prevent the infection, one should not wait for the extreme symptoms to show.
  • One should only involve the use of steroids in severe cases.
  • The only treatment that is effective against the disease is an anti-fungal intravenous injection that costs 3,500 rupees ($48) a dosage and must be given every day for up to eight weeks.
  • Dr. Rahul Baxi, a Mumbai-based diabetologist says,” One way to stall the possibility of the fungal infection was to make sure that Covid-19 patients – both in treatment and after recovery – were being administered the right dose and duration of steroids.”
  • “Doctors should take care of the sugar levels after the patients are discharged,” says, Dr. Baxi.

How To Detect or Diagnose The Black Fungus Infection?

  • Do not miss the signs and symptoms.
  • To diagnose fungal aetiology, tests such as KOH staining, microscopy, culture, and MALDI-TOF can be used.

States Where Black Fungus Is Prominent:

States where Black fungus is prominent are​4​,

  • Rajasthan, Under the Rajasthan Epidemic Act, 2020, the state government declared black fungus an epidemic and a notifiable disease on Wednesday. This notice was issued by the government to ensure integrated and coordinated treatment of black fungus and Covid-19. According to reports, Rajasthan has approximately 100 cases of black fungus. For their care, the state government has established a dedicated ward at Jaipur’s Sawai Man Singh (SMS) Hospital.
  • In Delhi, incidents of black fungus have also been reported. Max Hospital in the city has recorded 25 cases, AIIMS New Delhi (15-20 cases), Sir Ganga Ram Hospital (40 cases), and Moolchand Hospital has recorded a death connected to black fungus.
  • The King George Medical College in Lucknow, Uttar Pradesh has admitted 50 cases of black fungus. Six people have undergone surgery, and four have died, according to officials. Meanwhile, one patient has made a full recovery and has been discharged.
  • In Madhya Pradesh “nasal endoscopy” campaign will be launched for an early detection of black fungus and treatment of black fungus. Under the nasal endoscopy campaign the government of Madhya Pradesh will also provide free nasal endoscopy to Covid-19 patients and survivors who are admitted to district hospitals and government medical colleges.
  • In Haryana, according to Haryana’s health minister, Anil Vij, 115 cases of black fungus have been found so far in the state. He said the state government is taking a number of efforts, including establishing 20-bed wards for specialized treatment in medical colleges. All civil hospitals have been told to refer such people to medical colleges for better treatment. The Haryana government has formed regulations called ‘The Haryana Epidemic Diseases (Mucormycosis) Regulations, 2021’. All healthcare facilities, both government and private, will follow the guidelines for screening, diagnosis, management of mucormycosis, issued by the Centre and state governments and amended from time-to-time.
  • In the Maharashtra‘s Aurangabad, 16 individuals have died of black fungus in the last 40 days, according to officials. And according to the news agency PTI, 201 black fungus patients from various locations were hospitalized for treatment in Aurangabad health facilities between April 1 and May 10. 145 of the 200 patients underwent surgery, while the others were treated with a variety of medical procedures.

References:

  1. 1.
    Garg D, Muthu V, Sehgal I, et al. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature. Mycopathologia. 2021;186(2):289-298. doi:10.1007/s11046-021-00528-2
  2. 2.
    Priyanka R. A rare black fungus is infecting many of India’s COVID-19 patients—why? National Geographic. Published May 14, 2021. Accessed May 2021. https://www.nationalgeographic.com/science/article/a-rare-black-fungus-is-infecting-many-of-indias-covid-19-patientswhy
  3. 3.
    News staff I. ICMR releases diagnosis and management guidelines for COVID-19-associated Mucormycosis. Firstpost. Published May 17, 2021. Accessed May 2021. https://www.firstpost.com/india/icmr-releases-diagnosis-and-management-guidelines-for-covid-19-associated-mucormycosis-9628341.html
  4. 4.
    Wadhawan DA, Jain P, Kumar SS, New K. Rajasthan declares black fungus an epidemic; cases pile up in several states | 10 points. indiatoday. Published May 19, 2021. Accessed May 2021. https://www.indiatoday.in/coronavirus-outbreak/story/rajasthan-declares-black-fungus-an-epidemic-cases-pile-up-in-several-states-10-points-1804470-2021-05-19

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