A rare black fungus infects many of India’s COVID-19 patients — why?

On May 9, Ananyaa Mazumdar received a call and remained confused. A cousin who wants to be struck by her panic explained that her 48-year-old aunt, who recently recovered from a COVID-19 infection, lost most of her eyesight.

Doctors in the emergency room at Max Super Specialty Hospital in Ghaziabad, a satellite city on the outskirts of New Delhi, the capital of India, suggested that the infection was so advanced that immediate surgery was needed to remove the eyes. To my surprise, the family soon realized that they had no other choice.

“That was all I could do, and I had to do it,” said Mazdal. “It’s like sitting on a time bomb.”

Her diabetic aunt was diagnosed with a very rare fungal infection called Mucormycosis that is On an upward trend Among the recovering and recovered but vulnerable COVID-19 patients in India. Colloquially called “black fungus” because of its high pigmentation. Potentially deadly infections start in the nose and spread to the eyes and brain..

Public health experts have accused the indiscriminate use of steroids to treat COVID-19 as a possible cause. Steroids reduce lung inflammation. However, overuse of these drugs in COVID-19 patients can weaken immunity and increase blood sugar levels. These conditions make some patients, especially those with uncontrolled diabetes, vulnerable to such infections.

As India —The world’s diabetic capital-Continued Fight the devastating second wave of COVID-19, Otorhinolaryngologists expect more cases of mucormycosis in the coming weeks.

In Delhi, for example, Manish Munjar, an otolaryngologist at Sagangalam Hospital, has been treating nearly 15 new cases daily since last week. According to him, the city has recorded about 250 cases of mucormycosis since April.

“That’s a huge number,” he says, comparing it to one or two cases treated monthly during the pre-pandemic period.

In Maharashtra, western India, where COVID-19 was the hardest hit, Rajesh Tope, Minister of Health More than 2,000 patients with mucormycosis.. In the neighboring state of Gujarat 300 cases Reported from four cities.

“The concern is that this is just the beginning,” says Munjar. “Infections usually begin to affect the body 2-3 weeks after steroid therapy, and the number of cases can spike in the coming weeks.”

What is a black fungus?

Mucormycosis is an invasive infection caused by a class of mold called Mucormycosis. These fungi are everywhere, Naturally occurring in our environment, Most commonly in the soil. Humans are infected by inhaling fungal spores that are floating in the air or dust. These spores stay in the nasal and sinuses and cause disease in that area.

However, not all people exposed to spores are infected. “Most of the time, if you have a normal immune system, it’s an asymptomatic quiet encounter,” says Tobias Hall, head of infectious disease services at the Memorial Sloan Kettering Cancer Center in New York. However, the onset of invasive disease depends on a person’s health.

People with a weakened immune system, such as blood cancers receiving chemotherapy and bone marrow transplant patients who are unable to form neutrophils, a type of white blood cell that prevents infection, are victims of mucormycosis. May become.

Similarly, during the period of COVID-19, patients prescribed high-dose and long-term steroids may weaken the immune system. “I’ve seen people crazy about prescribing steroids,” says Lancelot Pinto, a pulmonologist at PD Hinduja Hospital and Medical Research Center in Mumbai. “There is a more serious misunderstanding among doctors. [COVID-19] In some cases, higher doses of steroids are required, which has not been supported in previous studies. “

Steroids can cause Soaring blood sugar level, This can be especially difficult for uncontrolled diabetics. Higher blood sugar and more acidic blood Fertile environment For the Mucorares fungus to propagate.

In such vulnerable patients, spores can germinate to form long tubular filaments that grow into the sinuses, bone, and bloodstream. Symptoms of mucormycosis and the progression of infections vary from person to person. They include throbbing headaches, fever, facial and nose pain, dark runny nose, loss of vision, toothache, loose teeth, swelling of the upper jaw, and sometimes facial paralysis.

“This is a horrific infection that can spoil the appearance,” says Hohl. “If left untreated, the infection can invade the central nervous system, which is more dangerous.” If the infection reaches the brain, there is a greater than 50 percent chance of death.

Early diagnosis can save lives. However, infections can be very difficult to treat, even in the early stages.

Treatment of mucormycosis

Patients are prescribed antifungal treatments such as liposomal amphotericin B injections for at least 10 days to several weeks after diagnosis. However, these essential medicines can cause substantial side effects, including kidney damage.

Surgical intervention is often also required. If less severe, the doctor inserts an endoscope through the nasal cavity to remove the diseased tissue. If the infection spreads further, the surgeon may need to remove the bones of the eyes or jaw.

At the Samadan Dental Super Specialty Center in Dhule, Maharashtra, oral surgeons and maxillofacial surgeons Rajesh and Schlenic Oswar have been treating nearly 50 ex-COVID-19 patients since April, 25 of whom are jaws. Is completely or partially excised and stopped. The disease has spread.

Ajinkya Kelkar, an otolaryngologist at the Maharashtra Medical Foundation Hospital in Pune, recently treated 12 patients with Mucorosis associated with COVID-19, two of whom had their eyes completely removed. Prior to the pandemic, he encountered 2-3 cases of mucormycosis each year.

“It’s a serious rise,” he says. “We didn’t expect it.” On Sunday, the Indian Medical Research Council said. Advisory For screening, management and diagnosis of zygomycosis in the age of COVID-19.

But so far, these unexpected infections pose new challenges for patients who are already physically, emotionally and economically depleted with recent COVID-19 infections.

The surge in demand for antifungal drugs has created a serious shortage, creating a backmarket for drugs that are already too expensive for most people to get. With an overwhelming medical system, finding a hospital where patients with mucormycosis can receive surgery and postoperative care can be another logistical nightmare.

Mucormycosis cases in India appear in only a small part of the total number of COVID-19 cases in the country, but there are concerns about an increase. To prevent such infections in the first place, public health experts emphasize that hospitals maintain hygiene, especially for equipment that supplies oxygen. They suggest that doctors carefully prescribe steroids and regularly monitor blood glucose levels in all COVID-19 patients in hospitals and at home, even during the post-recovery period.