What is ‘black fungus’ infection found in India’s COVID patients?

Indian doctors record a huge spurt in cases of mucormycosis, an aggressive, hard-to-treat fungal infection, among COVID-19 patients.

A woman walks past a graffito on a street amid the spread of the coronavirus disease in Mumbai [Francis Mascarenhas/Reuters]

Mumbai, India – For 35-year-old Milind Deshmukh, contracting the COVID-19 infection has been a devastating, life-altering experience.

The mechanical engineer from Thane, a suburb of Mumbai, caught a fungal infection known as mucormycosis while battling the viral disease.

In a span of a month, the fast-spreading fungus had eaten into a large portion of his facial tissue, including his right eye and the palate.

“He has undergone three surgeries, lost vision from one eye permanently and it is going to be difficult for him to talk or eat due to the removal of the palate,” Deshmukh’s elder brother Makarand told Al Jazeera. “It’s all so devastating.”

How many cases have been found?

Doctors in India have been recording a big spurt in cases of the aggressive, hard-to-treat fungal infection.

While mucormycosis cases have been seen in the country earlier, the current increase in infections is among people infected with COVID-19 and those who have recovered from the disease.

The numbers are far above cases before COVID-19  came into India.

“It’s a dangerous situation,” said Dr Milind Navalakhe, an ear, nose and throat (ENT) surgeon at Global Hospital in Mumbai who conducted the palate-removal surgery on Deshmukh.

In practice for nearly 25 years, Navalakhe would get about one case of mucormycosis in a week before the pandemic.

“Now, I am seeing as many as 25 mucormycosis cases in a week, all COVID-19 patients either currently on treatment or recovered,” he said.

The western state of Maharashtra, home to Mumbai, has recorded about 2,000 cases and eight fatalities due to mucormycosis so far.

The state’s health minister Rajesh Tope has announced the setting up of special wards in hospitals to treat the fungal disease.

What causes mucormycosis?

Mucormycosis, also known as black fungus or zygomycosis, is caused by a group of mould called mucormycetes.

These fungi live in the environment, particularly in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood, according to the Center for Disease Control and Prevention.

When someone breathes these fungal spores, they are likely to get the infection that commonly affects the sinuses or lungs.

Medical experts say mucormycosis is an “opportunistic infection” – it latches on to people who are battling illnesses or are on medications that lower the body’s ability to fight infections.

Patients with COVID-19 have weak immunity and a large number of them are put on steroids in order to control a hyperimmune response, thus making them susceptible to other fungal infections such as mucormycosis, say experts.

The majority of mucormycosis infections have been seen in COVID-19 patients with diabetes or those with underlying and undetected high blood sugar.

India’s poor air quality and excessive dust in cities such as Mumbai, make it easier for the fungi to thrive.

“There is also the rampant misuse and overuse of steroids and antibiotics in India which further allows such infections to spread,” said Navalakhe.

Is it spreading?

Doctors in India’s capital New Delhi have also started witnessing a spurt in cases of mucormycosis too.

The city, home to nearly 20 million people, is reeling under a vicious second wave of COVID-19, with doctors anticipating a larger outbreak of fungal infections.

“We are seeing two to three times higher numbers of mucormycosis cases,” said Dr Neha Gupta, an internal medicine and infectious disease specialist at Medanta Hospital in Gurugram, a suburb of the Indian capital.

She said patients are coming in with symptoms such as loose or falling teeth, severe facial pain and facial swelling.

“Earlier we would see rare mucormycosis cases among people who have met with road traffic accidents or those with severe diabetes. But now all cases are COVID-19 related,” she said.

Mucormycosis is also known to develop on the skin if the fungus enters through a cut, scrape, or other injuries. Patients who have undergone organ transplants are also known to be susceptible.

In the western state of Gujarat, hospitals have started preparing wards amid increasing cases of the fungal infection.

The state officials have also placed orders for the anti-fungal drug called Amphotericin-B, which is crucial in the treatment of mucormycosis.

While the Gujarat government has been notified about 100 such cases, doctors say the actual numbers could be much higher.

Dr Dinesh Harani, an ENT surgeon in Gandhidham in Kutch district of Gujarat, told Al Jazeera he has referred five mucormycosis patients for surgeries to Ahmedabad, the state’s largest city, in the past three days.

“I did not see a single case of mucormycosis in my 35 years of practice until now,” said Harani, who runs a small four-bed medical facility.

“The injection Amphotericin-B is also in short supply,” he said.

The Ahmedabad Civil Hospital has admitted 19 mucormycosis patients over the past week. Many government and private hospitals from other cities in the state, including Surat, Anand and Vadodara, have also reported cases.

The treatment for mucormycosis is expensive. Surgical removal of the infected tissue is the primary treatment for the infection, in addition to a long course of anti-fungal medication.

“Mucormycosis is like a fast-spreading cancer that invades the body,” Mumbai-based infectious disease specialist Dr Tanu Singhal told Al Jazeera.

“The overall treatment costs including the surgeries go up to 40,00,000 Indian rupees ($54,452) to 50,00,000 Indian rupees ($68,065).”

Source: Al Jazeera