By Dr Anita Mathew
Alongside COVID19, India now battles two types of fungal infections – Mucormycosis or ‘black fungus’ – a rare, yet lethal infection and Candidiasis also called the ‘white fungus’. Fungi is ubiquitous in the environment; also they are commensals in our mouth. Hence fungal infections are known to occur whenever there is reduced immunity like HIV, Cancer, and those on immunosuppressive drugs. Mucormycosis is a debilitating disease which even in pre-COVID times have been seen in poorly controlled diabetic patients. It’s treatment needs multidisciplinary approach of surgery to clear the disease and medicines to curb the spread. The important thing is to control sugars and keep it in check.
GOVERNMENT IS ALREADY PREPING UP:
In view of the rising numbers of the black fungus, the government has already begun to revamp up procurement and availability of Intravenous (IV) Liposomal Amphotericin B which is an anti-fungal medication. 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?
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. 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.
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 FOR THE BLACK FUNGUS?
Treatment of Mucormycosis involves a combination of surgical debridement of involved tissues and antifungal therapy. Intravenous (IV) Amphotericin-B, Posoconazole and Isavuconazole is part of antifungal therapy. The duration the treatment is of around 3wks, followed by oral medicines for another 3 to 6wks.
WHAT IS WHITE FUNGUS?
Candidiasis is an infection caused by a type of fungus called Candida. This too impacts people with immune-compromised state and lowered immunity such as people with HIV, Cancer, transplant surgery, Diabetes and so on. The symptoms of this fungal disease are similar to Coronavirus infection if it impact the Lungs. The disease can be detected by performing HRCT test on an infected patient.
CAUSE OF RISE IN FUNGAL INFECTIONS AMID COVID:
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.
SCREENING SHOULD BE RAMPED UP TO IMPROVE EARLY INTERVENTION AND AVIOD PANIC:
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 till the establishment of tissue diagnosis in high risk cases, which are clinically diagnosed, and started on treatment.
Right now, the nation is battling the pandemic on several fronts. The only way to tackle a crisis it through wise and informed approach. However, there is no need for panic. Judicious use of steroids, keeping strict diabetic control, maintaining oral and nasal hygiene will be helpful to reduce the risk of infection. To follow up with physician post covid will be important to diagnose case early. Both the government and the healthcare set-ups are geared up for the situation and is tackling it head on.
CITIZENS SHOULD PROTECT THEMSELVES:
The most effective way to prevent fungus infections 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 self medicate.
About the Author
Dr Anita Mathew, is the Infectious Disease Specialist, at Fortis Hospital, Mulund
