CHENNAI: Hospitals in Tamil Nadu have started reporting incidents of the rare but serious fungal infection known as mucormycosis and colloquially as 'black fungus'. Developing a standard protocol for steroid use in Covid treatment, management of diabetes during and after treatment and stocking of antifungal drugs may prevent the situation from getting out of control, say experts.
While there are no official figures on the number of cases in the country, some states like Rajasthan have declared black fungus as an epidemic and Puducherry alone has reported at least a dozen cases. The condition is being detected relatively frequently among Covid-19 patients in several states across India.
Dr Vijayalakshmi Balakrishnan, an Infectious Diseases consultant from Kauvery Hospitals, said, "Currently the majority of patients with mucormycosis here are from outside Chennai including from the Andhra border. But we are expecting a spike in cases soon."
The infection is accompanied by symptoms including sinusitis, headache, swelling of eyes or other visual disturbances, blackening on the facial skin, facial numbness, jaw ache and loosening of teeth. Usually people's immune systems are adept in fighting the black fungus. However those who are already ill or have a weakened immune system and high blood sugar levels are at a greater risk of getting infected by it.
"In the initial stages, the disease is painless and silent. So people do not know that something is wrong until it's too late," said Dr Somu Lakshmanan, Professor and HOD, ENT Head and Neck Surgery specialist at Sri Ramachandra Institute of Higher Education and Research.
ALL YOU NEED TO KNOW ABOUT BLACK FUNGUS IN INDIA:
He said that it is crucial that post-Covid, patients, particularly those with diabetes, get screened for mucormycosis. "The fungus thrives on someone with high blood sugar levels. While it is ideal for such persons to get a CT scan of the sinus, they should certainly get screened for mucormycosis if they have persistent headache, blackish or bloody nasal discharge, building in the eye or sudden facial pain," he advised. He added steam inhalation may help alleviate symptoms, but certainly not help preventing the infection.
Unfortunately, a commonly prescribed treatment for Covid is use of steroids to control the inflammation in the body. They work by suppressing the body's immune system from flaring up in order to reduce adverse symptoms. This is why Covid patients on steroids are susceptible to secondary infections like mucormycosis.
"Preventive approach is the most effective," said Dr K Kolandasamy, former Director of Public Health highlighting that inappropriate use of steroids in diabetic Covid patients has been the top reason for onset of mucormycosis. In order to reduce the incidents of mucormycosis, steroid treatment should be started at the right time and only in select cases, he recommended. "Only those with significant lung damage and hypoxia should be considered for steroids. Doctors should not start administering steroids early before needed," he said. He also advised that doctors should prescribe steroids only if blood test results show high levels of inflammation.
Director of Medical Education (DME) Dr. Narayanababu said that the Tamil Nadu government has already formed a committee to manage mucormycosis in the state. There is a three-pronged approach to control the increase in cases, he said. "One, we have advised the deans of all hospitals to do a thorough post-Covid follow-up of patients. Two, we have asked hospitals to use sterile water for humidifiers in oxygen cylinders and concentrators. Finally, a clean and a sanitary environment should be maintained at the hospital and homes after discharge," he said.
Explainer:
What is black fungus?
Mucormycosis or black fungus is caused by a group of fungal molds called mucormycetes. These fungi live throughout the environment, particularly in soil and in decaying organic matter, such as leaves,
compost piles or rotten wood.
Symptoms
- 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.
How to prevent it?
- Judicial use of steroid for Covid treatment
- Management of blood sugar levels during steroid treatment
- Post recovery follow-up and screening of the sinus
- Using sterile water in oxygen humidifiers and regularly cleaning equipment
- Staying in clean environment and entertain less visitors for the two weeks following recovery