CHENNAI: While the country is battling Covid-19’s second wave, black-fungus infection or Mucormycosis, a rare but a potentially life-threatening fungal attack, is on the rise. Recently, the Union health ministry had asked all states to classify the infection as a notifiable disease under the Epidemic Diseases Act, 1897.
Though there were indeed such infections in the past, the recent outbreak has raised a lot of questions due to the high mortality rate found in Covid-19 patients who contract the fungal infection. In conversation with The New Indian Express, Dr V Ashwin Karuppan, Consultant (Internal Medicine), Critical Care and Diabetology at Gleneagles Global Health City, shares his insights.
Q. What are the characteristics of Mucormycosis, and what are the symptoms patients who have this infection exhibit?
The fungus has been in existence for a long time, and it affects immunocompromised patients, those with uncontrolled diabetes, undergoing chemotherapy, having arthritis, and those who underwent organ transplantation. It spreads through the air and enters the sinus. Symptoms include swelling of face and eyes, blocked nostrils, brownish or black discharge from nostrils, low-grade fever, and redness of face.
Q. Do Covid-19 patients contract this infection because of the immunosuppression resulting from excessive use of steroids? Is this related to Covid-19 treatment? If so, how?
Steroids definitely play a role. When you give steroids to Covid-19 patients, you reduce inflammation in the body. But, it is a drug that will increase your blood-sugar levels as well. Steroids and diabetes causing immunodeficiency are the two primary reasons for the fungal-infection outbreak. Covid-19 patients are, thus, susceptible to the fungal infection.
Q. How is the fungal infection playing out differently during the second wave than during the first wave?
Firstly, we did not use this much oxygen in the first wave. We did not look into where the oxygen was produced back then, especially the industrial oxygen. This can also come from impurity of oxygen and from using old and unclean cylinders. Secondly, we have used a lot of drugs this time and the infection affects the immunocompromised patients more. The source of Mucormycosis needs to be identified to contain the outbreak.
Q. What is the mortality rate of this infection and does it spread to other parts of the body?
The mortality rate of Mucormycosis, in its advanced stages, is 80-90 per cent. Where there is an involvement of paranasal sinuses, palate, and eyes, the entire portion needs to be resected. This is the reason why mortality is high even in treated Mucormycosis cases. The infection can affect eyes, lungs, intestine, and skin too. Only when it gets closer to the brain and eye does it become difficult to treat. We have been treating it successfully in lung and organ-transplant patients in its early stages itself.
Q. Does this affect only those with co- morbidities or are healthy young people also susceptible to it?
Normally, people with co-morbidities with uncontrolled diabetes are the most affected. But, young people with immunosuppression can also contract the infection.
Q. How important is the drug Amphotericin B? What is the time duration within which this needs to be administered to the patient. And, how much might the treatment cost?
It is an important drug in the treatment of Mucormycosis and is usually given from 4 to 6 weeks. Improper use of the drug, however, can affect the kidneys and other parts of the body, causing more damage than the disease itself. It is also an expensive drug starting from Rs 7,000. Resection is also an expensive treatment. Early detection might help in better treatment.
Q. What is the duration of the course of treatment for patients with Mucormycosis?
Usually, around 6 to 8 weeks is sufficient for the therapy. Sometimes, it goes up to six months. It depends on how invading the fungus is. Even after therapy, we check other places in the body for lesions.
Q. With simultaneous disease outbreaks such as what we are witnessing, how should the public health surveillance strategy improvise itself in the coming years?
Firstly, the source of infection must be identified–whether it is from industrial oxygen or not. It is not a contagious disease and is spread only through some sort of source. Secondly, people need to be aware that the infection is out there. The government should also regulate steroid use; they must not be used left, right, and centre. They should be given to only those patients who actually need it. The government must also make available adequate amounts of drugs for the treatment of the infection. Studies need to be done on where the affected patients come from, how many patients are affected, where the clusters are. That is how we should fight the outbreak.
Q. What are some steps that people can take to keep themselves safe from Mucormycosis?
The best thing to do is to keep yourself healthy. Have adequate food and ensure other diseases like diabetes are under control. Patients need to find out when steroid use needs to be stopped and patients must watch out for symptoms of Mucormycosis. It is completely curable.