Explained: What Is ‘Black Fungus’ In Covid-19 Patients And How To Prevent It

The “Black Fungus” or Mucormycosis is a fungal infection that has been detected in many survivors of Covid-19 in India.

With several mucormycosis cases detected in Delhi, Gujarat and Maharashtra, the Indian Council of Medical Research (ICMR) and the Union health ministry have issued an advisory saying that it can turn fatal if left untreated.

It has an overall mortality rate of 50 per cent.

As per the Centers for Disease Control and Prevention (CDC) in the United States, this fungal infection is rare but very serious.

It is caused by a group of molds called mucormycetes, which live throughout the environment.

The infection mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.

According to CD, it can also occur on the skin after a cut, burn, or other types of skin injury.

Doctors in some states in India have noted the rise in such cases among people who are hospitalised or currently recovering from the coronavirus infection.

A Mumbai-based eye surgeon, Dr Akshay Nair, was waiting to operate on a 25-year-old woman on 8 May.

She was a Covid-19 patient but recovered about three weeks ago.

Inside the surgery, an ENT specialist was already at work on the woman, who is diabetic.

He inserted a tube into her nose and was removing the tissues infected with the fungal infection, which affects the nose, eye and sometimes the brain.

Once the ENT specialist completes his work, then Dr Nair would carry out surgery on the woman’s eye.

Dr Nair told BBC: "I will be removing her eye to save her life. That's how this disease [mucormycosis] works.”

This infection most commonly affects the sinuses or the lungs after inhaling fungal spores from the air.

It can be life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV-AIDS.

According to doctors, the black fungus may be triggered by the use of steroids, a life-saving treatment for severe and critically ill coronavirus patients.

Steroids reduce inflammation in Covid-19 patients’ lungs and can stop some of the damage that could happen when the body's immune system goes into overdrive to fight against Covid-19.

But the steroid treatments also reduce the body’s immunity and boosts blood sugar levels in both diabetics and non-diabetic patients suffering from Covid-19.

It is believed that this drop in the body’s immunity could be triggering these cases of black fungus.

"Diabetes lowers the body's immune defences, coronavirus exacerbates it, and then steroids which help fight Covid-19 act like fuel to the fire," explained Dr Nair, who has already come across around 40 patients who have been affected by mucormycosis.

He said that while many of them were diabetics and had recovered from Covid-19 at home, some patients had to have an eye surgically removed.

Meanwhile, The Indian Express reported that the Gujarat administration has announced that all government civil hospitals, especially in Ahmedabad, Vadodara, Surat, Rajkot, Bhavnagar, and Jamnagar, reporting incidents of mucormycosis, will set up separate wards to treat these patients.

The Gujarat government said that over 100 cases of black fungus have been notified across state government hospitals and Gujarat Medical Education Research Society (GMERS) hospitals.

Currently, Ahmedabad’s Zydus Hospital has about 40 such patients while Vadodara’s SSG hospital is treating 35 mucormycosis patients.

Fungus Infection Advisory

Considering the rise in such cases, the Centre has prepared guidelines on the management of the fungal infection in Covid-19 patients.

The warning signs and symptoms are — pain and redness around the eyes and/or nose, fever, headache, coughing, shortness of breath, bloody vomits and altered mental status.

The predisposition includes — uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, co-morbidities – post-transplant/malignancy and voriconazole therapy.

As per the ICMR and the Union Ministry of Health and Family Welfare, people should control hyperglycemia (high blood sugar), monitor blood glucose level post-Covid-19 discharge and also in diabetics.

They also advised to use steroids judiciously — correct timing, correct dose and duration and use sterile water for humidifiers during oxygen therapy.

The use of antibiotics or antifungals judiciously is also recommended.

However, the advisory also says that while people should not miss any of the symptoms, all cases with blocked nose should not be considered as cases of bacterial sinusitis, particularly in the context of immunosuppression or Covid-19 patients on immunomodulators.

Additionally, it says, “Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology.”

In terms of treatment, even though the infection can be treated with antifungals, mucormycosis may eventually require surgery.

Management of Covid-19 patients with this life-threatening infection would require a team effort involving all the experts such as microbiologists, internal medicine specialists, intensivist neurologist, ENT specialists, dentists, surgeons and others.

Dr Jayesh Sanaria, who is a dermatologist at an Apollo Hospital, said that people need to take measures to increase immunity.

“Diabetes patients should regularly monitor their sugar levels, especially when they have been prescribed steroids to treat Covid-19,” he said.

Additionally, he advised diabetes patients to contact their doctors to check whether they need to start insulin injections.

“To boost immunity, take green vegetables in the diet,” he suggested.

The doctor also urged people to get the Covid-19 vaccine, as he claimed that if people are inoculated, they will develop immunity due to antibodies, which will help prevent the development of severe coronavirus infection and chances of getting mucormycosis will also decrease.