Coronavirus Pandemic

India Covid Crisis: Lethal Black Fungus adds to patients' woes

Linah Baliga/Mumbai
Filed on May 8, 2021
Dr Shashikant Mhashal, assistant professor, ENT, Cooper Hospital, Mumbai, with a Covid-19 patient, who is recovering from mucormycosis. Supplied photo.

Medical condition is more pronounced among those suffering from blood sugar, doctors say

Afroz Shah, who had captured the public imagination in 2016 after the United Nations (UN) honoured him as a “Champion of the Earth” for leading the clean-up of the polluted Versova Beach in Mumbai, put out a distress message on social media on May 1.

The lawyer-turned-ecological warrior’s message was about his 81-year-old mother, who was undergoing a surgical procedure for mucormycosis at a private hospital.

What is mucormycosis?

For the uninitiated, it is a lethal rare fungal infection, which is also called the "Black Fungus", and has been detected among a section of Covid-19 patients. How do patients, who have contracted SARS-COV-2 that causes the viral disease get afflicted with mucormycosis?

Doctors attributed the “Black Fungus” among those Covid-19 patients, who are diabetic and have administered steroids. The medical condition has come to light among immunosuppressed patients across the western Indian state of Maharashtra, one of the epicentres of the second and more lethal contagion.

How potent is the “Black Fungus?”

Doctors said the fungus is fatal, disfigures the face and many patients have lost their eyesight.

Shah’s emotional social media post captured the trauma.

“I took the last picture of my mother, as she was about to enter the operation theatre (OT). Doctors had no option but to remove her left eye in a bid to protect her life. The fungus has reached her brain as well, and she is battling for her life. It’s traumatic. I bade goodbye to her, as she was wheeled into the OT with her eyes intact. She will be left without an eye, even if the fungus spares her life. May the pain and trauma ease for me and my family members. Prayers are the need of the hour,” said a distressed Shah during the Holy month of Ramadan, which started in India a day after the UAE on April 14, and the Eid-al-Fitr will be celebrated next week.

Doctors cutting across specialisation from ear, nose, and throat to dentists, maxillofacial surgeons, diabetologists, neurologists and critical care are worried about the sudden spike in mucormycosis case during the second wave of Covid-19.

Dr. Rajesh Yadav, an ENT consultant at Shatabdi Hospital and United Multispecialty Hospital at Kandivali, told that: “I’ve come across 25 cases of mucormycosis within a month. There have been cases where many have lost their eyesight.

When mucormycosis is detected, we’ve to remove the black fungus on time, or else it spreads in a patient’s body. If the infection reaches the brain, I’m afraid, nothing can be done.”

What are the tell-tale symptoms of the “Black Fungus”?

Dr. Yadav said it starts with swelling in the face along with a runny nose, which is often ignored by a Covid-19 patient.

“These symptoms are devastating complications of a Covid-19 infection. There is a rise in orbital, sinonasal and the worst is rhinocerebral, when the fungus reaches the brain," he added.

Dr. Yadav stressed that if the fungus attacks the eyes, nose and palate, these body parts can be removed to save a patient’s life, but the disfigurement could be a traumatic experience for the afflicted.

"Our aim is to prevent rhinocerebral mucormycosis to prevent the fungus from spreading to the brain which can be detected through an MRI or a CT scan. Once it spreads to the brain, we remove the sinuses and the orbit parts and manage it with medication," Dr Yadav added.

Dr. Shashikant Mhashal, assistant professor, ENT, Cooper Hospital, Mumbai, said he came across 26 cases of mucormycosis within a month.

"I’ve operated upon five patients. Usually, the immunity of Covid-10 patients, who suffer from diabetes, is low. They require steroids and due to the high flow of oxygen, there’s a dryness from the mucosa. There is uncontrolled sugar. Many patients came with facial pain, double vision, lack of vision, and other ophthalmic issues," he said.

Dr. Mhashal has not only been treating patients from Mumbai but also other parts of Maharashtra such as Jalgaon and Nandurbar.

"In the past three weeks, I’ve come across three patients who have lost their eyesight. After discharge they don't control their blood sugar, which leads to this complication," he said.

Dr. Mhashal said that mucormycosis develops after a Covid-19 patient is discharged from a hospital, during treatment, or at times because of oxygen contamination.

"Covid-19 is basically a thromboembolic phenomenon. Thrombosis of the vein to the nasal cavity causes this disease. This is mainly found in patients, who are administered drugs for cytokine storm, where the body starts to attack its own cells and tissues rather than fighting off the virus, and uncontrolled diabetes," he said.

Diabetic patients should ensure their blood sugar is in control; should take care of the nose by not letting the black crust grow around it.

"They should take a normal saline wash. If they come early with symptoms, there are fewer chances of the fungus reaching the orbit of the brain. Early diagnosis with nasal care and blood sugar control are the key to prevent this rare medical condition," he added.

Dr. Yadav said that when patients are put on oxygen, the secretion of the nose becomes dry and, as a result, the use of saline wash is prescribed.

"Saline wash clears secretions from the nose and no fungus can grow," he added.

News of black fungal infections from Ahmedabad, Gujarat, another western Indian state, comes days after doctors at a leading Delhi hospital told news agency PTI "we are seeing a rise again in this dangerous fungal infection", NTDV has reported.

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