After Covid-19, Black Fungus Sweeps India
By Staff, CNN
In early May, doctors in India began raising the alarm about a rise in mucormycosis, a rare and potentially deadly infection also known as black fungus.
Many of those being infected are coronavirus patients, or those who have recently recovered from Covid-19, whose immune systems have been weakened by the virus or who have underlying conditions, most notably diabetes.
In the past few weeks, thousands of black fungus cases have been reported across the country, with hundreds hospitalized and at least 90 dead. Two states have declared it an epidemic, and the central government has made it a notifiable disease.
Black fungus is caused by mold found in damp environments like soil or compost, and can attack the respiratory tract. It is not contagious and does not spread from person to person.
Several types of fungi can cause the disease. These fungi aren't harmful to most people, but can cause serious infections among those with weakened immune systems, according to the United States Centers for Disease Control and Prevention [CDC].
Black fungus commonly affects the sinuses or lungs after a person inhales fungal spores in the air, and can also affect the skin following a surface injury like a cut or burn. Symptoms depend on where in the body the fungus is growing, but can include facial swelling, fever, skin ulcers and black lesions in the mouth.
The disease "begins to manifest as skin infection in the air pockets located behind our forehead, nose, cheekbones, and in between the eyes and teeth," said the Indian Health Ministry in a statement on May 14. "It then spreads to eyes, lungs and can even spread to the brain. It leads to blackening or discoloration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing of blood."
"One of the ways mucormycosis travels is by invading the blood vessels," said Dr. Hemant Thacker, consultant physician and cardio-metabolic specialist at Breach Candy Hospital in Mumbai. "It compromises the circulation to the distal organ, and thus produces what is called as necrosis or death of tissue, which then becomes black. So it is then given the name black fungus."
In the most severe cases, the infection "goes through the blood vessels into the brain," potentially causing loss of eyesight or creating a "gaping hole" in the face, he added. "If not controlled, not treated, it can have a mortality [rate] of anything from 20% to 50%."
Immunocompromised people are more susceptible to infection, including Covid-19 patients, diabetic patients, people who take steroids, and those with other comorbidities like cancer or organ transplants, said the Indian Health Ministry.
Covid patients are particularly susceptible because not only does the virus affect their immune system, treatment drugs can also suppress their immune response. "Due to these factors, COVID-19 patients face a renewed risk of failing the battle against attacks mounted by organisms such as mucormycetes," said the ministry, referring to the fungi that cause mucormycosis.
Additionally, Covid patients undergoing oxygen therapy in ICUs may have humidifiers in the ward, which can raise their exposure to moisture, and make them more prone to fungal infection, said the ministry.
Black fungus is treated with antifungal medicines, often given intravenously, according to the CDC. The most common medicines include Amphotericin B, a drug currently being used in Indian states to combat the outbreak.
Patients may need up to six weeks of anti-fungal medicine to recover. Their recovery depends on how early the disease was diagnosed and treated.
Often, surgery is required to cut away dead or infected tissue. "In some patients, this may result in loss of upper jaw or sometimes even the eye," said the Indian Health Ministry in its statement.
