A top surgeon said, “the disease, also known as ‘black fungus’, can infect people who have been treated with oxygen for the coronavirus.”
India has been battling a surge in COVID-19 cases recently. Fortunately, the number of new cases has plummeted in recent days.
However, the nation is now dealing with an outbreak of a fungal disease with a 50% mortality rate.
The rare fungal disease mucormycosis has killed more than 300 people and infected more than 12,000 in India as the country’s health system continues to grapple with Covid-19. A surgeon at a Delhi hospital told FRANCE 24 that the disease, also known as ‘black fungus’, can infect people who have been treated with oxygen for the coronavirus.
The deadly fungus moves rapidly in the body, attacking the nose, eyes, jaw and brain. Patients need immediate surgery to survive, but they are left with disabilities.
Black fungus can be treated with anti-fungal injections like Amphotericin B, but with the rising number of cases in India, there is an acute shortage.
The fungus targets the sinuses and bones of the face and then can invade the brain or cause patients to lose an eye. When it goes untreated, it can be lethal. The number of cases is related to the treatments given to COVID-19 patients and the prevalence of diabetes in some areas of India.
These fungal infections arise after a COVID diagnosis, which seems to be a clue. A standard component of treatment for severe cases of COVID is high doses of corticosteroids, anti-inflammatory drugs that damp down the immune system’s overreaction to infection. Steroids save lives, but they simultaneously make a patient more vulnerable to attack by whatever bacteria or fungi are already in their body or hanging around their environment.
“Fungal spores are everywhere, but we are pretty efficient at clearing them from our lungs,” says Arturo Casadevall, a physician and molecular microbiologist at the Johns Hopkins Bloomberg School of Public Health. “But COVID damages the lung. So then you have a double whammy: reduced capacity to naturally clear the spores and reduced immune response as a result of steroids.”
That collision of factors is complicated by something else. Years before COVID appeared, researchers in Australia and Europe, as well as India, all reported that mucormycosis seemed particularly ferocious in patients with uncontrolled diabetes. That is setting Indian COVID patients up for disaster. “Even in rural areas, every eighth adult aged 30 and beyond is diabetic,” Kalantri says. “Most have suboptimal control of sugar. When these patients test COVID-positive, they often are prescribed high-dose steroids, often in the first week. Irrational and unscientific treatment of COVID is extremely common.”
To complicate matters, India is struggling to obtain enough doses of the antifungal drug Amphotericin-B.
Supplies of the antifungal drug amphotericin B are now arriving in Maharashtra, but there had been an initial shortage as such case numbers had not been anticipated, said Lahane, the state official.
The state ordered 100,000 vials of amphotericin B last week, according to Tope. “There are very few districts where there aren’t patients (with black fungus),” Tope said, as people across several states, including Uttar Pradesh, Maydhya Pradesh, Delhi and Telangana, appealed for supply of the drug.
In Gujarat, a western state north of Maharashtra, the High Court issued an order on Monday warning of “the rapid increase in the cases of flesh-eating black fungal infection called ‘mucormycosis.'”
“The shortage of injections being administered for the said disease and the cost of its treatment are also the issues which deserve to be seriously and immediately considered by the State,” the order said.
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