Rare fungal infection hits Covid-19 patients in India

More and more patients in India who have recovered from Covid-19 are finding that they have to battle yet again with another pathogen.

Doctors across the country are reporting a surge in a rare fungal infection known as mucormycosis among those cured of Covid-19 as well as those recovering from it, adding to India's burden amid its ongoing acute health crisis.

Colloquially referred to as "black fungus", mucormycosis is a highly fatal disease caused by a group of moulds called mucormycetes that are commonly found in the environment, such as in soil or in decaying organic material.

Most people have the immunity necessary to fight it off but the fungus can find easy entry into those who are immuno-suppressed, most commonly through inhalation, with its spores spreading rapidly from sinuses and infecting other body tissues.

"It is worrying because it is something that spreads rapidly in the patient's body," said Dr Roshni Nambiar, an ear, nose and throat (ENT) surgeon based in Mumbai, who has operated on some mucormycosis patients.

"The time between a person being diagnosed and potentially not making it can be the span of a couple of days," she told The Straits Times. "It is really aggressive."

In Ahmedabad's Civil Hospital, the number of mucormycosis cases has already crossed more than 200 since last month. Doctors treated around 150 such patients between January last year and March this year. The hospital has had to set up separate wards to accommodate these patients, adding around 30 to 40 beds daily since the past week.

Yesterday, even as the government and health workers continued to battle an ongoing devastating second wave, India's Health Minister Harsh Vardhan tweeted a set of dos and don'ts for better management of mucormycosis patients.

The country yesterday reported 343,144 new Covid-19 cases over the last 24 hours, taking its total caseload past the 24 million mark, with another 4,000 deaths added to its tally.

Dr Maqsood Ali Khan, an ENT and skull base surgeon in Mumbai, told ST he has seen a rise in mucormycosis patients as well. He operated on three such patients last year, but in the last two months, Dr Khan has had to operate on around 15 mucormycosis patients.

"I have removed sinus tissues, I have removed eyes, I have removed palate bones… It depends upon the extent of the disease," he said.

Patients require timely surgery for removal of infected and dead tissues in order to avoid the fungus from spreading to other parts of the body such as the brain and causing fatalities. This is combined with anti-fungal drug therapy that usually lasts six to eight weeks.

A surge in mucormycosis cases is not entirely out of place given the higher number of Covid-19 cases in India during the current second wave of infections. Such patients, with their lower levels of immunity, provide a fertile ground for the fungus to proliferate.

Also known as the "black fungus" infection or zygomycosis, mucormycosis is caused by a group of mould called mucormycetes.

In the environment, particularly soil and decaying organic matter, such as leaves, compost piles or rotten wood.

By inhaling the fungal spores, which can attack the sinuses or lungs.

People who have health problems or take medicines that lower the body's ability to fight germs and sickness.

The rare but deadly infection can kill and maim patients, with some Covid-19 sufferers losing their upper jaws and eyes after contracting it.

Pain and redness around the eyes and nose, shortness of breath, bloody vomiting and an altered mental state.

Steroids, prescribed to Covid-19 patients to reduce lung inflammation, also suppress immunity and cause a rise in sugar levels. The second wave has seen a pronounced trend in self-medication among those recovering at home, leading to concerns on excessive use of steroids.

Uncontrolled diabetes is another contributing factor as it provides a conducive environment for the mucormycetes fungi, which is known to thrive in high-glucose, high-iron and acidic conditions.

Patients even risk catching the fungi from contaminated water while using oxygen concentrators.

The surge in mucormycosis patients has also led to a shortage of Amphotericin B - the anti-fungal drug prescribed for such patients. In a statement on Wednesday, the government said it is working with manufacturers to ramp up production of the drug and added that it is increasing imports as well.

Dr Bela Prajapati, head of the ENT department at Ahmedabad's Civil Hospital, said even patients who had recovered from Covid-19 must check their blood sugar levels every week and recommended nasal endoscopy for those who report common symptoms associated with mucormycosis such as facial pain or drooping eyelids.