Diabetics suffering from COVID-19 who are being given steroids have a high chance of being affected by mucormycosis or “black fungus”, All India Institute of Medical Sciences (AIIMS) Director Randeep Guleria said on Saturday, as hospitals report a rise in the rare but potentially fatal infection. Mucormycosis spores are found in soil, air and even in food. But they are of low virulence and usually do not causes infection. There were very few cases of this infection before Covid. Now a large number of cases are being reported due to Covid,” he said at a news briefing.
A large number of mucormycosis patients who have recovered from the COVID-19 infection have been found in Maharashtra and Gujarat. Several of them are suffering from blindness.
In Maharashtra, at least eight COVID-19 survivors have died due to mucormycosis while 200 others are being treated, said Dr Tatyarao Lahane, who heads the Directorate of Medical Education and Research of the state government.
How Black Fungus infects a COVID-19 patient
This disease is not new, but it is rising among COVID-19 patients in India because the excessive use of steroids elevates sugar levels and some medicines suppress the immunity of these patients leading to loss of vision and death in some cases.
Patients suffering from the fungal infection typically have symptoms of stuffy and bleeding nose; swelling of and pain in the eye; drooping of eyelids; and blurred and finally, loss of vision. There could be black patches of skin around the nose.
Doctors say most of their patients arrive late, when they are already losing vision, and doctors have to surgically remove the eye to stop the infection from reaching the brain. In some cases, doctors in India say, patients have lost their vision in both eyes. And in rare cases, doctors have to surgically remove the jaw bone in order to stop the disease from spreading.
Sinuses or lungs of such individuals get affected after they inhale fungal spores from the air. Doctors in some states have noted a rise in cases of mucormycosis among people hospitalized or recovering from Covid 19, with some requiring urgent surgery. Usually, mucormycetes does not pose a major threat to those with a healthy immune system.
What causes the black fungus infection?
When the immunity of a person is low, they are vulnerable to this infection.
This condition is not new; it has been seen earlier as well, but there are more cases now. It was seen in patients with diabetic ketoacidosis (excess blood acid) and those who are in the ICU are immuno-compromised have cancer or patients who have had kidney transplant or are on immuno-suppressants.
Symptoms of Black Fungus aka mucormycosis
• Facial Deformity
• Facial pain
• Nasal congestion
• Loss of vision or pain in eyes
• Altered mental state, confusion
• Swelling in cheeks and eyes
• Toothache, loosening of teeth
• Black crusts in the nose
What happens when one contracts it?
Warning signs include pain and redness around the eyes or nose, with fever, headache, coughing, shortness of breath, bloody vomits and altered mental status. According to the advisory, infection with mucormycetes should be suspected when there is:
- Sinusitis — nasal blockade or congestion, nasal discharge (blackish/bloody);
- Local pain on the cheek bone, one-sided facial pain, numbness or swelling;
- Blackish discoloration over 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.
The Covid diabetic are more vulnerable to black fungus. Extra care should be taken to ensure that the pH of blood does not become more acidic and sugar levels are near-normal. Even if a person is Covid positive or is on heavy antibiotics, his/ her immunity is weak—they should keep track of their blood pH to avoid this infection.
What’s the treatment?
While it is treated with antifungals, mucormycosis may eventually require surgery. Doctors have said that it is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs. To maintain adequate systemic hydration, the treatment includes infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks.
Experts in the task force have stressed the need to control hyperglycemia , and monitor blood glucose level after discharge following Covid-19 treatment, and also in diabetics. One should use steroids judiciously — correct timing, correct dose and duration are important
Do’s and don’ts
• Do not avoid the signs and symptoms of black fungus infection. It can be very dangerous if it reaches the brain.
• Control hyperglycemia.
• Monitor blood glucose level post-COVID-19 discharge and also in diabetics
• Use steroid judiciously – correct timing, correct dose and duration.
• Contact an ENT doctor immediately, contact an eye expert or contact a doctor who is treating a similar patient.
• Follow the treatment every day. If you have diabetes, then monitor blood sugar
• If there is any other disease, keep taking medicines and monitor it
• Do not take steroids or any other medicines on your own. Take medication only after consulting the doctor.
• Use antibiotics/antifungals judiciously.
• Do not consider all the cases with a blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
• Do not lose crucial time to initiate treatment for mucormycosis.
Changes to the eyes or vision distortion could also be warning signs of the infection spreading, experts warn. As the black fungi grows and spreads, vision can be distorted as well. Some people may also experience a sort of swelling in one eye, have hazy or poor vision, or develop bloodshot eyes.