(CNN) – In early May, doctors in India began to warn of an increase in mucormycosis, a rare and life-threatening infection also known as black fungus.
Many of those 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 diseases, especially diabetes.
In recent weeks there have been thousands of cases of black fungus throughout the country, with hundreds of hospitalized and at least 90 deaths. Two states have declared the epidemic, and the central government has made it a notifiable disease.
This is what we know about the black fungus and its spread in India.
How is it contracted and what are the symptoms?
Black fungus is caused by a mold found in humid environments like soil or compost, and it can attack the airways. It is not contagious and is not passed from person to person.
Several types of fungi can cause the disease. These fungi are not harmful to most people, but they can cause serious infections among those with weakened immune systems, according to the Centers for Disease Control and Prevention (CDC).
Black fungi usually affect the sinuses or lungs after a person inhales airborne fungal spores, and can also affect the skin after a superficial injury such as a cut or burn. Symptoms depend on where the fungus grows on the body, but can include facial swelling, fever, skin ulcers, and black lesions in the mouth.
The disease “begins to manifest itself as a skin infection in the air pockets behind the forehead, nose, cheekbones and between the eyes and teeth,” the Indian Ministry of Health said in a statement on 14 of May. ‘Then it spreads to the eyes, the lungs and can even spread to the brain. It causes blackness or discoloration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing up blood ».
India Faces Drug Shortage to Treat ‘Black Fungus’, Rare Infection Increasing Among Covid-19 Patients
“One of the ways mucormycosis travels is by invading the blood vessels,” says Dr. Hemant Thacker, consultant physician and cardiometabolism specialist at Breach Candy Hospital in Bombay. “It compromises the circulation to the distal organ, and thus produces what is called necrosis or death of the tissue, which then turns black. That is why it is called the black mushroom ».
In the most severe cases, the infection “travels through the blood vessels to the brain” and can cause loss of sight or create a “huge hole” in the face, he added. “If it is not controlled, it is not treated, it can have a mortality (rate) of 20% to 50%.”
According to the CDC, a 2005 study of 929 cases dating back to 1885 revealed an overall death rate of 54%. The death rate also depends on the type of fungus involved and the part of the body affected. For example, it is less deadly for people with sinus infections, but more deadly for those with lung infections.
What is the relationship with covid-19?
What immunological mechanisms cause a patient with covid-19 to get worse?
Immunosuppressed people are more susceptible to contracting the infection, such as COVID-19 patients, diabetics, people taking steroids and those suffering from other comorbidities, such as cancer or organ transplants, according to the Indian Ministry of Health.
Covid-19 patients are especially susceptible because the virus not only affects their immune system, but the treatment drugs can also suppress their immune response. “Due to these factors, covid patients face a new risk of not being able to fight against the attacks of organisms such as mucormycetes,” explained the ministry, referring to the fungi that cause mucormycosis.
Covid patients receiving oxygen therapy in intensive care units may have humidifiers in the room, which can increase their exposure to humidity and make them more prone to fungal infection, the ministry said.
“The fungus seizes the opportunity, invades the body,” Thacker said. “This body has a small opening because of the covid, because of the sugars (high glucose levels), because of the antibiotics, because of so many other things, (the black fungus) gets a hole.”
The Ministry warned that “this does not mean that all covid patients will be infected with mucormycosis”, as it is rare among those who do not have diabetes.
According to the National Health Portal of India, the prevalence of diabetes in the country is between 12% and 18% of the adult population, especially in urban areas.
“India is the diabetes capital of the world,” says Thacker of Breach Candy Hospital. “We have tropical climates in which fungi are aggravated. So all this has caused the black fungus epidemic.
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How is it treated?
Black fungus is treated with antifungal medications, often given intravenously, according to the CDC. The most common drugs are amphotericin B, a drug currently being used in Indian states to combat the outbreak.
Patients may need up to six weeks of antifungal medications to recover. Your recovery depends on how quickly the disease has been diagnosed and treated.
Surgical intervention is often required to cut off dead or infected tissue. “In some patients, this can result in the loss of the upper jaw or sometimes even the eye,” the Indian Ministry of Health said in its statement.
The demand for amphotericin B is increasing in India, but it is in short supply as hospitals had not anticipated the number of cases.
Bhavya Reddy, a resident of southern India’s Telangana state, said her father was diagnosed with the black fungus on April 26, just as he was recovering from COVID-19.
“Once he started to recover (from covid) his face started to swell,” Reddy said. “When the swelling didn’t go down, (the doctors) told us to give ourselves the injection.” The hospital did not have a supply of Amphotericin B, and had to appeal to the chief minister of state to receive the ampoules of the drug, he said.
After getting the medicine, his father underwent endoscopic sinus surgery to relieve inflammation.
Mansukh Mandaviya, deputy minister of the Ministry of Chemicals and Fertilizers, tweeted on Thursday adding that five companies have been approved to produce the drug in India, in addition to the existing six.
How common is it?
The disease is found worldwide and is generally quite rare, although it can be difficult to make an exact estimate of its prevalence due to a lack of comprehensive data and surveillance.
In the United States, laboratory surveillance in the San Fancisco Bay area between 1992 and 1993 suggested an annual rate of 1.7 cases per million people, according to the CDC.
However, the disease appears to be more common in India: a study by Indian microbiologists, published in March in the journal Microorganisms, suggests that black fungus is 70 times more prevalent in India than in global data.
There are several possible reasons for this: There is a higher rate of “uncontrolled diabetes” in India, according to the study. Many of the patients studied did not even know they had diabetes until they were diagnosed with black fungus, demonstrating “the lack of regular medical check-ups in the Indian population,” the study notes.
A woman waits while a black fungus-infected patient receives treatment at a public hospital in Hyderabad, India, on May 20.
The death rate for black fungi in India is also “considerably high due to delays in seeking medical care and diagnosing the disease, and difficulties in treating the advanced stage of the infection,” the study notes.
The country’s climate is also a factor, Thacker said. “This fungus can grow on the side of bread that is kept outside,” he said.
“It can grow anywhere in the form of mold, but in tropical countries with humidity … it tends to proliferate.”
The current outbreak could also be due to the fact that “we are in summer, it is hot and there is humidity,” he added. “Everyone knows that fungal infection is worse in these types of climates.”
Where have you registered?
So far more than 3,200 cases of black fungus have been recorded in the five states of Maharashtra, Madhya Pradesh, Haryana, Telangana and Gujarat.
Maharashtra has the largest number, with more than 2,000 registered cases and 800 hospitalized. At least 90 people have died from the disease in the state.
Gujarat has reported at least 369 cases in a single hospital.
On Thursday, the central government classified mucormycosis as a notifiable disease, which means that all states and territories in the union have to report their cases to federal authorities.
“Now we have a new black fungus challenge, we have to be cautious and prepare for it,” Indian Prime Minister Narendra Modi said on Friday.
At least seven states have declared black fungus a notifiable disease, in accordance with the central government’s recommendation to collect data, according to the authorities of the respective state governments.
“These cases are being found in patients who have recovered from covid, so there are a number of complications,” said JV Modi, medical superintendent at Ahmedabad Civil Hospital in Gujarat. He added that the hospital has seen an increase in cases in the past 10 days, at a time when the country appeared to be passing the peak of its second coronavirus wave.
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