Decoded: What is black fungus and its link to Covid-19 pandemic

India has a huge diabetic population that is at risk. And along with that, steroids and antibiotics are being used quite irrationally for Covid-19 patients

As India struggles with a deadly second wave of Covid-19, cases of a rare fungal infection called “mucormycosis” have been reported in several states. Also known as black fungus, the life-threatening disease has infected many Covid-19 patients including those who have recovered. Although it is not yet classified as an outbreak, as the number of cases continues to grow, here is what you need to know:
 
What is mucormycosis or black fungus and what causes it?
 
Mucormycosis is an infection caused by a fungus called mucormycete present in the environment. Infections can occur in the sinuses and spread to the brain and lungs, and the fungi can also enter the body through the skin or spread through the bloodstream and affect other organs such as the heart and spleen. The soil, manure, plants, damp walls, et al are common sources of black fungus infection. According to doctors, it has an overall mortality rate of 50 per cent and is potentially fatal for diabetics and those with low immunity such as HIV/AIDS and cancer patients.

 

What are its symptoms?
 
According to recent guidelines issued by the Indian Council of Medical Research (ICMR), black fungus can induce warning signs and symptoms that include pain and redness around eyes and/or nose, fever, headache, coughing, shortness of breath, bloody vomits and altered mental status. It advises Covid-19 patients, diabetic or immunosuppressed individuals to suspect possible infection if they experience symptoms such as sinusitis, one-sided facial pain, numbness or swelling, blackish discolouration over bridge of nose/palate, blurred or double vision with pain, fever, skin lesion and chest pain.
 
Why has Covid-19 led to a spurt in cases of black fungus? Are people in India particularly prone to it?

 
There are a number of reasons behind the black fungus cases among Covid-19 patients in India. Covid-19 leads to immunosuppression in people resulting from dysregulated immunity (inability to control or restrain an immune response) that the viral disease causes in the body, says S Chatterjee, an internal medicine specialist at Indraprastha Apollo Hospital, New Delhi. “This holds true for the entire world. But India has a huge diabetic population that is at risk. Even if it’s a tiny fraction of the population, it is a large number. And along with that, steroids and antibiotics are being used quite irrationally for Covid-19 patients,” he adds.

 
Chatterjee says anything that causes an immunocompromised state can expose an individual to a fungal infection like mucormycosis. “We all carry bacteria and fungi, some of which help maintain a healthy biological ecosystem in the body. That gets disturbed and the good bacteria and fungi die when you use medications irrationally,” he says, adding that in India a lot of the treatment of Covid-19 patients is being guided by their relatives and friends who put pressure on doctors to administer a particular drug. Doctors have called for judicious use of anti-cancer drugs such as tocilizumab to treat Covid-19. Chatterjee says that tocilizumab is an immunomodulator (that suppresses or stimulates the immune system), which can compromise immunity and in turn make the patient prone to various infections including black fungus.

 
How can you treat and prevent black fungal infection?
 
The treatment of mucormycosis involves monitoring and control of blood sugar, antifungal medication that includes the drugs amphotericin B and posaconazole, and surgery that is required to control the spread of the infection at an advanced stage.
 
For its prevention, people are advised to wear shoes, trousers, long-sleeved shirts and gloves while out gardening, use masks while visiting construction sites and maintain personal hygiene including through scrub bath. The list of dos that is part of ICMR’s guidelines for Covid-19 and diabetic patients includes use of clean and sterile water for humidifiers during oxygen therapy. Measures to manage mucormycosis include controlling diabetes, reducing steroids with an aim to discontinue them rapidly, discontinuing immunomodulating drugs and extensive surgical debridement (medical removal of dead, damaged or infected tissues to increase chances of healing for the healthy tissues).