NEW DELHI: The rising number of mucormycosis cases in India may have come to limelight in the second Covid19 wave but this dreaded disease has been growing alarmingly since last year, a new study has confirmed.
This study from India, published by the US Centre for Disease Control and Prevention in its New Infectious Diseases journal has shown that between September and December, 2020, a 2.1-fold rise in black fungus cases was seen in the country, as compared to the corresponding period during the previous year.
The findings also showed that mortality rate among such patients had remained the same at around 47% at 12 week and 38% at 6 weeks.
Over the past few months, mucormycosis, a rare infection, normally caused after exposure to mucor mould commonly found in soil, plants, manure, and decaying fruits and vegetables has emerged as a major public health concern in India and is being reported in many people during or after Covid infection.
The condition, with a very high mortality rate affects the sinuses, the brain, eyes and the lungs and can be particularly life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or HIV-infected persons.
Researchers from 16 major tertiary care centres in the country including AIIMS in Delhi and Bhopal, PGI Chandigarh and several private hospitals like Gangaram hospital in Delhi and Medanta in Gurugram found 287 mucormycosis cases in September-December, 2020. Of these, 187 or over 65% of were reported in Covid patients.
“We noted a 2.1-fold rise in mucormycosis during the study period compared with September–December 2019,” they noted in US CDC’s journal.
The retrospective study found that uncontrolled diabetes mellitus was the most common underlying disease among all mucormycosis patients, irrespective of whether or not it was associated with coronavirus.
Also, Covid19 was the only underlying disease in 32.6% of those mucormycosis patients who had probably got the disease due to coronavirus infection. Also, Covid19 related hypoxemia (low oxygen in blood) and improper glucocorticoid use were independently associated with coronavirus associated mucormycosis.
The mucormycosis case-fatality rate at 12 weeks was 45.7% but it was similar for CAM and non-CAM patients, noted the researchers.
They added that age, rhino-orbital-cerebral involvement, and intensive care unit admission were associated with increased mortality rates while sequential anti-fungal drug treatment improved mucormycosis survival.
“The Covid-19 pandemic has led to an increase in mucormycosis in India, partly from inappropriate glucocorticoid use,” their findings said.
However, as 13 of those cases were not treated with glucocorticoid or other immunomodulatory therapies, authors noted: “Whether Covid19 itself causes immune dysregulation and predisposes patients to invasive mucormycosis remains an unproven possibility”.
Meanwhile, the government which has been struggling to fulfill the heavy demand of anti-fungal drug amphotericinB by states had said that as on June 16, there were over 27,000 active mucormycosis cases in the country—a large number of which were in Gujarat and Maharashtra.