Sukalpa Dhar, Kolkata: With the Corona Virus pandemic increasing day by day deaths due to black fungus or mucormycosis is another major manace that looms largely over the people.
The government of India has declared black fungus an epidemic.
Mucormycosis is a very rare fungal infection affecting 1 in 10 lakh people but with an overall mortality rate of 50%. The source of this fungal infection can be found in soil, air and upto some extent it is said that it is found in food too.
Usually it doesn’t create infection. It is found among recovered Covid patients. Now what are the symptoms that one needs to look at and worry about?
The warning signs are : (i) sinus pain or nasal blockage on one side (ii) blurry vision (iii) toothache (iv) loosening of teeth (v) difficulty in chewing and opening mouth (vi) abnormal black discharge or crust or blood from the nose.
This infection was prevalent even before the time of covid 19 but the cases were very rare. It was a rare infection. It was seen among patients who had very high diabetes and those who had transplants and are under immunosuppressant drugs or cancer patients who are under chemotherapy. Usually it was not seen in general people. So it is not a new disease. But due to the undergoing Covid 19 treatment of the patients the cases of black fungus are found more and more in them.
AIIMS have reported 23 cases that are affected with this black fungus. Among them 20 are still now Covid 19 positive patients and 3 Covid 19 negative patients.
How does it affect the human body? It affects the face which is called Rhino-orbital cerebral mucormycosis. Due to which the infection can spread in the orbit of eyes, nose and brain. This may lead to blindness or at times brain infection. It may spread in the lungs too which is called pulmering mucormycosis.
Cerebral mucormycosis can cause headache, block nose, blood may flow out from the nose. One side of the face may get numb or the skin gets discoloured. If the fungus occurs in lungs then chest pain may occur, fever, cough. Along with cough blood may also come out.
But the most important issue is that why this fungal infection happening more now? Because of covid19 it is a risk factor. In Covid 19 infection if we talk about blood counts one of the cell lines which is called lymphocytes gets reduced and becomes lymphopenia.
That is why the CD4CDet cells in the body gets reduced and for that the chances of occurrence of opportunistic infection and fungal infection gets increased. If the sugar of a diabetic patient doesn’t remain under control there is a lot of probability of being effected with this fungal infection. Miss use of steroids is also a very important reason for this fungal infection. The covid 19 patients who are given steroids and if they are also diabetic, then the chances of fungal infection increases. To stop this we have to reduce misusing steroids.
The patients who have mild disease and who doesn’t need oxygen and who have got covid 19 infection of early stage doesn’t need steroid. If it is not necessary steroid should be avoided otherwise excessive use of steroids may lead to fungal infections in future especially if the patient has diabetes too.
Researchers say that mild and moderate steroids are good enough. High dose of steroids should never be used. If high dose of steroids are used then the sugar level will increase and the infections will increase too. The data also shows that the majority of covid19 patients requires steroids maximum of 5 to 10 days. If steroids are used for a long time then controlling sugar becomes more difficult and hence, the chances of catching black fungus also increases.
What we should do for our precautions? (a) Use distilled or mineral water in oxygen humidifiers (b) Change water daily (c) Change oxygen mask and catheters regularly (d) Use steroids judiciously (e) Control sugar level (f) control diabetes (g) always monitor your sugar level (h) always use N95 masks.
Especially, when we are going towards any construction site we should were N95 masks because there the chance of catching fungal infection is very high (i) full face examination in day light.
The states which are hit by the fungal infection are Telangana, Odisha, Karnataka, Tamil Nadu, Rajasthan, Gujarat, and Haryana.
These states have already declared black fungus as a notified disease. From West Bengal, four cases of black fungus involving patients from Bihar and Jharkhand have been reported. They were reported by the eye hospital chain Disha.
Among the four cases three of them are men aged between 35, 40 and 50 and the other is the 65 years old woman. Two of the patients are undergoing treatment at a hospital in Durgapur. The AIIMS has issued a set of guidelines in case of detection of black fungus in a patient.
These are:
1. Immediate consultation with an ENT doctor, ophthalmologist, or the doctor who is treating the patient in case of any abnormal findings
2. Regular treatment and follow-up. Strict control and monitoring of blood sugar in diabetics
3. Regular medications and follow-up for other comorbidities
4. No self-medication with steroids or antibiotics or antifungal drugs
The signs to detect black fungus are:
(i) sinus pain or nasal blockage on one side
(ii) blurry vision
(iii) toothache
(iv) loosening of teeth
(v) difficulty in chewing and opening mouth
(vi) abnormal black discharge or crust or blood from the nose
In Assam, the Assam health department has issued a new Standard Operating Procedure (SOP) for Black Fungus or Mucormycosis after it has been suspected to have detected in a 27-year old boy who succumbed to the disease at Apollo Hospital in Guwahati.
The SOP contains details about symptoms, management of COVID-19 patients with black fungus infection and advisory for the general public, and treatment protocols.
Elaborating on black fungus infection, it said, mucormycosis is a rare serious fungal infection caused by a group of molds called mucormycetes. People can be infected with black fungus by coming in contact with its spores in the environment.
It can also develop in the skin after the fungus enters the skin through a cut, burn, or other types of skin trauma, the advisory said.
People who have uncontrolled diabetes mellitus, and immune-suppressed patients, those in ICU for a prolonged period, people with HIV or malnutrition, and those on steroids for medical cause need to be careful if they develop nasal blockage, facial or cheekbone pain, blackish and foul-smelling nasal discharge, congestion or redness and swelling of eyes and nose, and difficulty in vision.
To save the life of the patient the doctor has to surgically remove all the infected tissues. Patients might need an intravenous anti-fungal procedure spanning four to six weeks.
Doctors are currently using Liposomal Amphotericin B for treating black fungus infections.
As many as 20 vials of this injection are required to treat each infected person. According to reports each vials costs between Rs 5,000 and Rs 6,000.
The availability of this medicine is also currently alarming, because its supply is controlled by the government. In its absence, some doctors have said they’ve moved to second-line drugs like Posaconazole. We are definitely hopeful that the scientist will very soon come up with a solution for this black fungus too just like we have got the corona virus vaccine within a year’s turn.
