11/05/21

Black fungus stalks COVID-19 patients in India

Fungal
A woman undergoes a check-up. The new strain of COVID-19 virus can cause patients’ blood sugars to shoot up, creating a suitable environment for mucormycosis. Copyright: Trinity Care Foundation, (CC BY-NC-ND 2.0). This image has been cropped.

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  • Black fungus poses threat to COVID-19 patients in India
  • Shortage of antifungal drug amphotericin B adds to problems
  • Fears that mucormycosis cases may increase COVID-19 morbidity

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[NEW DELHI] A fungal disease called mucormycosis is emerging among hundreds of COVID-19 patients in India, placing further strain on hospitals already at breaking point.

The US Centers for Disease Control and Prevention (CDC) said that mucormycosis, also known as black fungus, is a “serious but rare” infection caused by a group of moulds called mucormycetes. It usually affects the sinuses or lungs after fungal spores are inhaled from the air but can also occur on the skin after a cut or burn.

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The Indian government has not yet announced the number of mucormycosis cases among patients with COVID-19, but media reports say there are more than 400 victims in Gujarat, 200 in Maharashtra and several others in the hospitals of Delhi, Bengaluru and Hyderabad cities.

Diptendra Sarkar, a COVID-19 strategist, public health analyst and professor at the Institute of Post Graduate Medical Education and Research, Kolkata, India, tells SciDev.Net that extensive use of immunosuppressant drugs for the treatment of COVID-19 may be responsible for the rising incidence.

“This is more common amongst diabetics, transplant patients, prolonged high-dose steroid recipients and patients on cancer chemotherapy,” Sarkar explains. “Though the incidence is sporadic, busy ICUs [intensive care units] can become epicentres for the surge in [mucormycosis] cases and create a huge challenge to health resources.”

According to Raghuraj Hegde, consultant eye surgeon at Manipal Hospital, in Bengaluru, India, the virulence of the new strain of COVID-19 virus causes patients’ blood sugars to shoot up, which in turn provides a suitable environment for mucormycosis. “The steroids used in COVID-19 treatment possibly add fuel to the fire already raging,” he tells SciDev.Net.

“The steroids used in COVID-19 treatment possibly add fuel to the fire already raging”

Raghuraj Hegde, Manipal Hospital

In a recent statement, Vinod Paul, a member of the government think tank the National Institution for Transforming India (NITI Aayog), says there is no major outbreak of mucormycosis in the country. However, reports from the states present a grimmer picture.

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On 8 May, a tweet from the Gujarat Chief Minister’s Office said that the state government has decided to start separate wards for mucormycosis patients at civil hospitals in Ahmedabad, Vadodara, Surat, Rajkot, Bhavnagar, and Jamnagar.

The government has also ordered 5,000 injections of the antifungal drug amphotericin B to treat mucormycosis, according to the tweet.

On 10 May, the government of Maharashtra announced free treatment for mucormycosis for everyone in the state, under a government-run health insurance scheme.

Akshay Nair, oculoplastic surgeon at the Aditya Jyot and Dr Agarwals eye hospitals in Mumbai, says the increase in mucormycosis cases is alarming because the healthcare system is already overburdened with COVID-19 cases. The additional burden of patients requiring urgent diagnosis and care due to mucormycosis adds further pressure on the healthcare system, he tells SciDev.Net.

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According to Nair, mucormycosis was an extremely rare condition and the availability of amphotericin B was adequate. “Now, a sudden increase in the utilisation of this drug has depleted available stocks leading to shortages,” he explains.

“The state governments should ensure adequate production, storage and delivery of amphotericin B, and take up strict administrative measures to stop hoarding and black-marketeering of the drug,” Shantanu Panja, consultant ENT surgeon at the Apollo Gleneagles Hospital in Kolkata, tells SciDev.Net.

This piece was produced by SciDev.Net’s Asia & Pacific desk.