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Defeating the ‘black fungus’ epidemic in India

By Dr Anita Mathew

Alongside COVID19, India now battles Mucormycosis or ‘black fungus’ – a rare, yet lethal infection. The latest NPPA report states that the government has revamped up the procurement and availability of Intravenous (IV) Amphotericin B (lipid formulation) which is an anti-fungal medication to fight the black fungus. The supply position is expected to improve with extra imports of this drug and increase in its production domestically. Moreover, states have been requested to put in place a mechanism for equitable distribution of supplies amongst Government, Private hospitals and health care agencies. Given thus, the Maharashtra government set up a taskforce as the state is witnessing a three to four times surge in Mucormycosis.

WHY IS THE BLACK FUNGUS SO DANGEROUS? 

Mucormycosis is a serious but rare fungal infection caused by a group of mold called Mucormycetes. It causes blindness, organ dysfunction, loss of body tissue, and even death if not treated on time. Therefore, active screening and early intervention are a must. It can affect areas from where it can be inhaled through the nose/ sinus/ lung. If it enters from a wound or skin, it can cause a local infection. But if it enters from the sinus, it can involve the eyes and brain. Poor control in Diabetes is the biggest cause for the rising number especially post-COVID. Also, patients with immune-compromised systems or those who have undergone transplants or people who are on immunosuppressants or on a ventilator for a long period of time are at higher risk. 

According to the taskforce advisory, infection with Mucormycosis should be suspected when there is:

  • Sinusitis – nasal blockage or congestion, nasal discharge (blackish/ bloody)
  • Local pain on the cheekbone, one-sided facial pain, numbness or swelling
  • Blackish discoloration over the bridge of nose/palate
  • Loosening of teeth, jaw involvement
  • Blurred or double vision with pain
  • Thrombosis, necrosis, skin lesion
  • Chest pain, pleural effusion, worsening of respiratory symptoms

WHY AMPHOTERICIN B IS EFFECTIVE?

Treatment of Mucormycosis involves a combination of surgical debridement of involved tissues and antifungal therapy. Intravenous (IV) Amphotericin-B is part of antifungal therapy. The usual starting dose is 5 mg/kg daily of Liposomal Amphotericin-B or Amphotericin-B Lipid Complex, and many clinicians will increase the dose up as high as 10 mg/kg daily to control this infection. But this cannot be taken without the doctor’s prescription and is to be administered only in an hospital setting. The duration of this treatment is 3wks, followed by oral medicines for another 3 to 6wks.

SCREENING SHOULD BE RAMPED UP TOO: 

Screening for the black Fungus is a crucial step for early intervention. Also, elimination of predisposing factors for infection, such as Hyperglycemia, Metabolic Acidosis,  immunosuppressive drugs, and Neutropenia, is also critical. Due to the difficulties in establishing a definitive diagnosis, many patients will be empirically treated for Mucormycosis because they have risk factors for infection and positive cultures and/ or compatible clinical syndromes. But this again will depend on the patient’s case.

Right now, the nation is battling the pandemic on several fronts. The new worry about the black fungus is only perpetuating the problem. While the governing authorities and healthcare providers have braced themselves to confront the problem, it is the duty of the citizens as well to protect themselves and their loved ones.

CITIZENS SHOULD PROTECT THEMSELVES: 

The most effective way to prevent the black fungus is to wear a mask while venturing out, especially to gardens, dusty areas, where there is garbage bumping or food rotting. Secondly, wear long clothes and have less exposure to skin. Most importantly for diabetic and other immune-compromised people, controlling sugar levels and blood glucose is a must. People who are prescribed steroids should be constantly monitored and the dosage should be reduced in consultation with your doctor. Importantly, steroids must only be taken after consulting with your doctor – do not semt medicate.

About the Author

Dr Anita Mathew, is the Infectious Disease Specialist at Fortis Hospital, Mulund 

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