Deadly 'Black Fungus' In Covid Patients In India: 10 Facts (courtesy: NDTV)

The disease, which can lead to blackening or discolouration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood, is strongly linked to diabetes.

NDTV (New Delhi: May 10, 2021):

The government has told doctors to look out for signs of mucormycosis or "black fungus" in COVID-19 patients as hospitals report a rise in cases of the rare but potentially fatal infection.

Here are the top 10 facts on the Black Fungus infection:

(1)  The Indian Council of Medical Research (ICMR) said at the weekend that doctors treating COVID-19 patients, diabetics and those with compromised immune systems should watch for early symptoms including sinus pain or nasal blockage on one side of the face, one-sided headache, swelling or numbness, toothache and loosening of teeth.

(2)  The disease, which can lead to blackening or discolouration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood, is strongly linked to diabetes.

(3)  Covid-19 patients more susceptible to contracting the fungal infection include those who used steroids during their virus treatment, and those who had prolonged stays in hospital ICUs, the ICMR added.

(4)  And diabetes can in turn be exacerbated by steroids such as dexamethasone, used to treat severe COVID-19. "There have been cases reported in several other countries - including the UK, the US, France, Austria, Brazil and Mexico, but the volume is much bigger in India," David Denning, a professor at Manchester University and an expert at the Global Action Fund for Fungal Infections charity, told news agency Reuters.

(5)  Media reports have pointed to cases in Maharashtra and state capital Mumbai, and Gujarat. Aparna Mukherjee, a scientist at ICMR, said, "It's not something to panic about, but you have to be aware of when to seek consultation."

(6)  Arunaloke Chakrabarti, head of the Centre of Advanced Research in Medical Mycology in Chandigarh, said that even before COVID-19, mucormycosis was more common in India than in most countries, "partly because of the millions who have diabetes".

(7)  P Suresh, head of opthalmology at Fortis Hospital in Mulund, Mumbai, said his hospital had treated at least 10 such patients in the past two weeks, roughly twice as many as in the entire year before the pandemic. All had been infected with COVID-19 and most were diabetic or had received immunosuppressant drugs. Some had died, and some had lost their eyesight, he said.

(  The Health Ministry on Sunday released an advisory on how to treat the infection. "The cases of mucormycosis infection in Covid-19 patients post-recovery is nearly four to five times than those reported before the pandemic," Ahmedabad-based infectious diseases specialist Atul Patel, a member of the state's COVID-19 taskforce, told news agency AFP.

(9)  Some 300 cases have been reported so far in four cities in Gujarat, including its largest Ahmedabad, according to data from state-run hospitals. The state ordered government hospitals to set up separate treatment wards for patients infected with "black fungus" amid the rise in cases.

(10)  Treatment involves surgically removing all dead and infected tissue and administering a course of anti-fungal therapy. But Yogesh Dabholkar, an ear, nose and throat specialist at Mumbai's DY Patil Hospital, told AFP that the drugs used to treat those infected with the fungus were expensive.

https://www.ndtv.com/india-news/deadly-black-fungus-in-covid-19-patients-in-india-10-facts-2439043?pfrom=home-ndtv_bigstory

"As Black Fungus Cases Rise, Health Minister On Symptoms, Do's And Don'ts"   (NDTV: May 14, 2021):

New Delhi:  Union Health Minister Dr Harsh Vardhan on Friday advised people on the early detection and management of Mucormycosis - commonly known as Black Fungus, a rare but serious condition that has been reported in a number of coronavirus patients, especially in Maharashtra.

"Awareness and early diagnosis can help curb the spread of the fungal infection," the minister said as he shared four slides on the fungus, symptoms and required action once someone contracts the infection.

Here are the frequently asked questions on the disease that were addressed by the minister:

What is Mucormycosis?

Mucormycosis is a fungal infection mainly affecting people with medical health problems that reduces their ability to fight environmental pathogens.

How can a patient contract the infection?

People having co-morbities, variconazole therapy, uncontrolled diabetes mellitus, immunosuppression by steroids or prolonged ICU stay can get predisposed to the fungal infection.

What are possible symptoms of Mucormycosis?

Pain or redness around the eyes, fever, headache, coughing, shortness of breath, bloody vomit and altered mental status are possible symptoms of the infection, the minister added.

"Don't consider all cases of blocked nose as cases of bacterial sinusitis, especially in the cases of immunosuppression and/ or COVID-19 patients on immunomodulators," the minister advised in his tweet.

Mucormycosis has become a talked about subject after a few recovering and recovered COVID-19 patients were found infected with the fungus.

Maharashtra Health Minister Rajesh Tope has said there could be over 2,000 such cases in the state as of now, and with more and more COVID-19 cases coming up "their number would increase for sure".

https://www.ndtv.com/india-news/covid-19-as-black-fungus-cases-rise-health-minister-harsh-vardhan-tweets-ways-to-manage-it-2441489

"Misuse of steroids major cause behind mucormycosis (black fungus) infection: AIIMS chief" (The Hindustan Times, May 15, 2021):

AIIMS director Dr. Randeep Guleria on Saturday warned that cases of mucormycosis infection, commonly known as the 'Black Fungus', arein the wake of the coronavirus disease (Covid-19) among particularly susceptible patients. Misuse of steroids is a major cause behind this infection, he said, adding that patients who are diabetic or Covid-19 positive and are taking steroids have an increased chance of contracting the fungal infection.

To prevent the mucormycosis infection, misuse of steroids must be stopped, said the director of the All India Institute of Medical Sciences (AIIMS) in New Delhi. Dr. Guleria added that such secondary infections, which include fungal and bacterial, are causing more mortality in recent days, even as Covid-19 cases keep on increasing. It is thus all the more important to properly follow protocols of infection control practices at hospitals, he said.

Where are mucormycosis spores found?

Mucormycosis spores are found in soil, air, and even in food, said the AIIMS chief.

In a new advisory over black fungus infection, the central government asked people to be extra careful regarding infection protocols since the mucormycosis fungus enters the body through a cut, scrape, burn, or other types of skin trauma when the skin comes in contact with fungal spores in the environment.

As such, a few of the conditions in which a Covid-19 patient might find themselves to be at an increased risk of the mucormycosis infection are:

1. If they are visiting dusty construction sites without masks.

2. If they are not wearing shoes, long trousers, long sleeve shirts, and gloves while handling soil (gardening), moss, or manure.

3. If they have experienced prolonged hospital or ICU stay.

4. If they are co-morbid, have undergone organ transplant, or are suffering from cancer.

5. If they are not maintaining personal hygiene properly in general.

Covid-19 patients need to be wary of steroid 'misuse'

Dr. Randeep Guleria, AIIMS chief, said that the mucormycosis fungal spores are of low virulence and usually do not cause infection. There were very few cases before Covid-19, but a large number of cases are only being reported in recent times due to the coronavirus disease infection, which affects immunity. Since steroids like dexamethasone also repress the immune system, it is necessary to be extra careful regarding its use, now more so than ever.

"Overuse, misuse, and rampant use of steroids in Covid-19 patients cause black fungus, also known as mucormycosis," said Dr. Suresh Kumar, medical director of LNJP hospital in New Delhi.

He said that steroid use must be reduced. "If given to patients with oxygen levels over 90, black fungus is a possible side-effect. Early diagnosis is critical. A CT scan of the face would detect this infection, after which antifungal drug amphotericin will be used for treatment," he said.

"Quite often a patient dies due to black fungus (mucormycosis) instead of Covid-19," Dr. Suresh Kumar added.

https://www.hindustantimes.com/india-news/misuse-of-steroids-major-cause-behind-mucormycosis-infection-aiims-chief-101621078067509.html

Black fungus: Experts flag role of industrial Oxygen

(Aditi Tandon: Tribune News Service -- New Delhi, May 21, 2021)

With Covid-induced mucormycosis spreading faster across all states, experts have asked the government to determine the possible role of industrial oxygen in the infection.

Dr Uma Kumar, rheumatology head, AIIMS, New Delhi, said doctors had been using steroids routinely in rheumatology patients, but they had never seen such high cases of mucormycosis.

“Is this Covid playing with the immunity to invite mucormycosis or is it due to the use of industrial oxygen?” Kumar said, urging the ICMR to look into the issue.

Experts say unhygienic delivery of oxygen to Covid patients could be a potential cause of black fungus infection. The recent shortage of medical oxygen led to industrial oxygen diversion to hospitals, but questions around its clean transport loomed.

Government experts have attributed black fungus epidemic to a combination of Covid, diabetes and irrational steroid use that suppresses immunity.

Ramakant Panda, another expert, claimed unhygienic delivery of oxygen to patients was the root cause. He said medical oxygen as opposed to industrial oxygen was highly purified. “It undergoes a range of processes such as compression, filtration and purification. Even its cylinders undergo disinfection and cleanliness processes,” he said, pointing to a possible role of unclean delivery of industrial oxygen for Covid treatment use as a probable reason for the black fungus surge.

Meanwhile, the first study by Indian researchers on the spread of mucormycosis published today in international journal Elsevier found overall 101 cases of mucormycosis in Covid patients worldwide — 82 from India and 19 from the rest of the world.

https://www.tribuneindia.com/news/nation/black-fungus-experts-flag-role-of-industrial-oxygen-256498