Black fungus infection in India
Medicine Physician

A Black Fungus Infection Is Killing Covid-19 Patients in India

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June 10, 2021
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How Covid-19 and its treatments create a breeding ground for black fungus infection. 

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Black Fungus Infection, India’s New Pandemic

“The black fungus infection has now become more challenging than Covid-19,” says Dr. VP Pandley, head of Maharaja Yeshwantrao Hospital. “If patients are not treated in time and properly, then the mortality rate can go up to 94%.”

India’s second surge of Covid-19 resulted in an increase of recorded new cases from around 11,000 per day in February 2021 to over 315,000 in April 2021 – a pandemic world record for a 24-hour period. Overall, India reports over 27 million cases and over 311,000 deaths, and still counting. The region is the new epicenter of the Covid-19 pandemic. 

Covid-19’s disease pattern ranges from mild to life-threatening infections, including pneumonia with associated bacterial and fungal coinfections. When combined with comorbid diseases like diabetes mellitus, chronic obstructive pulmonary disease, and immunosuppression, patients are prone to severe opportunistic infections. Like the black fungus infection (mucormycosis). 

The spread of black fungus infection in India is supported by a high abundance of Mucorales in the community and hospital environment, a large community of susceptible hosts (diabetic and immunocompromised individuals), and a high level of neglect for regular medical health checkups due to lack of access to qualitative healthcare and low standards of living. 

Black fungus in India

Source: thalabhula/depositphotos.com

The National News reported over 12,000 cases of rare black fungus infection in Covid-19 patients in India, in only the past few months. To contrast, a study conducted between January 2016 and September 2017 revealed just 465 total cases in the area. And just like the Covid-19 pandemic, the disease is spreading to other parts of the world; Pakistan, Russia, and Bangladesh have also recorded infections.

Most experts link its spread to the increased use of steroids used to combat the pandemic, a less than optimal level of personal hygiene, dirty hospital equipment, and prolonged use of ventilators and other medical equipment. 

Sure, this is not the first time India is reporting an outbreak of this deadly fungal infection. However, due to its association with Covid-19 and the country’s high burden of diabetes mellitus, the spread of the disease has become almost impossible to manage. 

Information from the US Center for Disease Control and Prevention shows that the black fungus infection has a mortality rate of 54%. This makes it the second deadliest fungal infection after aspergillosis, which carries a mortality rate of 66-100% depending on the route of infection. Black fungus’ severity and mortality rate varies depending on the patient’s condition or the affected body, and its aggressive form affects the eyes, nose, and brain. 

Mucormycosis

Source: katerynakon/depositphotos.com

What Is Black Fungus Infection?

Black fungus infection is rare and it affects the brain, the orbit of the eye, and the face and nose. It leads to vision loss and can spread to the brain and lungs, where it can damage tissue and cause death. The disease is precipitated by exposure to mucor molds found in soil, plants, manure, and decaying fruits and vegetables. Since the spores are airborne and can be inhaled, it is not uncommon to black fungus in the nose and mucus of healthy people.

Unlike Covid-19, black fungus infection is not new. It was first reported by Paltauf (a German pathologist) in 1885 as “mycosis mucorina.” Covid-19 has exacerbated its spread – as mentioned, the frequent use of steroids, monoclonal antibodies, broad-spectrum antibiotics, and ventilators used in the Covid-19 management creates an optimal environment for the fungus to take hold. 

signs and symptoms of black fungi infection

Source: millerinna/ depositphotos.com

While the fungal spores may not cause problems in healthy individuals, chances of coming down with the disease increase for immunocompromised patients and those with underlying conditions such as diabetes, prolonged use of corticosteroids, solid organ or hematopoietic stem cell transplantation, hematological malignancies (lymphoma, leukemia, and multiple myeloma), metabolic acidosis, intravenous drug abuse, prematurity, and advanced age. To make matters even more difficult, 2009 research identified black fungus infection as a nosocomial infection, which means it can be contracted from hospitals. Antifungal prophylaxis, bandages, medication patches, intravenous catheters, and tongue depressors all pose risk.

How Patients Contract Black Fungus Infection

The disease is established when immunocompromised individuals inhale the spores of black fungus, or the spores come in contact with a cut or skin trauma. If on the skin, black fungus may cause a localized infection, while inhalation via the sinus is what can lead to blindness and brain damage. 

Patients suffering from black fungus infections have reported sinus pain, nasal blockage on one side of the face, swelling or numbness, unilateral headache, toothache, and loosening of teeth. Advanced forms of the infection can bring about blurred vision, discoloration or blackening of tissues on the nose and cheeks, and the presence of black lesions in the mouth or discharge from the nose. 

Is Black Fungus Disease Contagious?

Transmission via human-to-human or animal-to-human contact is extraordinarily rare for black fungus disease. However, the infection can spread through airborne spores, fomites, or the environment, which are almost impossible to avoid. Unless you are immunocompromised, have one of the above-listed underlying conditions, or have a cut or skin trauma where the spores can enter your body, you are safe . 

Always practice good personal hygiene and report to your physician immediately if you feel unwell. Patients suffering from black fungus infection can be treated successfully if it is detected early. However, and sadly, a primary treatment option involves the removal of the affected eye or eyes. Intervention is crucial though, since severe cases of the infection can lead to brain damage and death. 

mucormycosis

Source: bhati.gajendra@gmail.com/ depositphotos.com

Takeaways

1) Black fungus disease was first reported in humans in 1885. 

2) The chances of black fungus infection increase with underlying medical conditions such as diabetes, organ transplant, prolonged use of broad-spectrum antibiotics, and corticosteroids.

3) The recent outbreak of the infection in India is largely attributed to the increased cases of Covid-19 coupled with a high level of diabetes and less than optimal hygiene. 

4) Black fungus infection is extraordinarily serious, and its burden in India challenges that of Covid-19. Treatment options often include surgical removal of affected eyes, and if not addressed quickly, patients can suffer brain damage or death.

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SOHAIL MERCHANT
Youngstown, Ohio

Medical Doctor (M.D.); Research Fellow at Lumen Foundation Artificial Intelligence Division

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