Black fungus, an added worry in Covid-19 infection

Monika Yadav New Delhi | Updated on May 13, 2021

Early detection is the key, say experts

Black fungus — Mucormycosis — has made a comeback, adding to the woes of coronavirus infected. According to healthcare professionals, while it was rare earlier it is seen in many Covid patients nowadays.

Mucormycosis is caused by a fungi which infects the nose, eyes, brain and sinuses. Experts are trying to ascertain the exact cause for the sudden surge of the fungus infection in Covid patients with uncontrolled diabetes and who are heavily dependent on corticosteroids and immunomodulators. Similarly, patients on mechanical ventilation and long standing oxygen therapy are also found to be vulnerable to this lethal fungus.

Though there is no official number on the fungal cases in India, estimation of fungal burden using computational models predicts around 1,750-2,500 cases of mucormycosis daily. Actual numbers may be still higher, said Rakesh Pandit, a doctor at Aakash Healthcare, New Delhi.

“We feel that during Covid times mucormycosis has made a comeback and the reason for this is simple - prolonged immunosuppression,” Rahul Bhargava, Principal Director, Hematology, Haemato Oncology & BMT, Fortis Memorial Research Institute (FMRI), Gurugram, said.

‘Aggressive infection’

“We have admitted five cases of severe mucormycosis presented with vision loss, headache and neural involvement. Compared to last year’s wave this mucor is more fulminant and very aggressive in nature, even coming in early stages of Covid disease. The way we are getting calls I believe we are heading for a nightmare ahead,” Atul Mittal, head of ENT at FMRI, said.

“Steroids reduce inflammation in the lungs of Covid-19 patients. However, the steroids also reduce immunity and push up blood sugar levels in both diabetic and non-diabetic patients. This drop in immunity could be triggering these cases of mucormycosis,” said Bhavika Verma, ENT Surgeon at ENTOD International.

Early detection is key

An early detection of mucormycosis in high suspicious cases of Covid-19 can prevent further complications and lead to best outcomes with reduced morbidity and mortality. “Complications of mucormycosis can be dire: blindness, organ dysfunction, loss of body tissue and death,” said Pandit.

According to Mittal, ENT examination and diagnostic nasal endoscopy form the basis for diagnosis.

“It is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs. To maintain adequate systemic hydration, the treatment includes infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks,” Verma noted.

One should use steroids judiciously — correct timing, correct dose and duration are important, she further added.

Published on May 13, 2021

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