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Black fungus: How infection starts, death rate, treatment, medicine & other key things to know

 


Synopsis

Black fungus, or mucormycosis, is a complication caused by a fungal infection. This is a relatively rare but potentially fatal condition.



Black fungus, or mucormycosis, is a complication caused by a fungal infection. This is a relatively rare but potentially fatal condition.

Amid a rise in such cases across India side by side with Covid, doctors have sounded the alarm over a "pandemic within a pandemic".

The Centre has requested states to make it a notifiable disease. It is also taking steps to address the shortage of Amphotericin B, the drug required to treat the disease

Black fungus infections have been detected in Karnataka, Uttarakhand, Telangana, Madhya Pradesh, Andhra Pradesh, Haryana and Bihar, among others. While some states have made it a notifiable disease, some like Rajasthan have already declared it an epidemic.

How does one catch black fungus?
Primarily, fungal spore floating in the environment gives people this infection. One may also catch it when the fungus "enters the skin through a cut, burn, or other types of skin trauma."

On coming in touch, the fungus can stick to a body part, and after a point travel inward through the nose, sinus or lungs.

If the fungus goes in through a cut or a burn, it can cause local infections. 

But if it goes in through the sinus, it can affect the eyes and eventually, the brain, leading to a fatal situation.

Some doctors think that black fungus took root when medicines were administered to at-home Covid patients without bringing their blood sugar levels under control. Some others say that it swamped immuno-suppressed systems owing to unclean, unhygienic post-Covid living conditions of patients.

According to AIIMS chief Randeep Guleria, doctors under pressure and patients in panic are making the situation worse. "There’s sometimes a knee-jerk reaction among physicians, who choose aggressive medical treatments instead of being conservative," he said.

Mucormycosis cases are also rising because of overuse of cheap steroids — seen in cases where there is a need to bring an exaggerated inflammatory response to Covid under control. 
Steroids suppress the immune response, which can increase vulnerability to secondary infections like black fungus.

The use of ordinary tap water inflow meters of oxygen cylinders is also being blamed for such fungal infections. Cases may be triggered by "mold-tainted oxygen pipes and humidifiers".

What are the symptoms of mucormycosis?
Some early signs of the condition include "sinus pain or nasal blockage on one side of the face, one-sided headache, swelling or numbness, toothache and loosening of teeth," says the Indian Council of Medical Research (ICMR).

According to reports from various top hospitals across India, patients are reporting "blurred vision, discolouration or blackening of tissue on nose and cheeks and black lesions inside the mouth or discharge from the nose."

How are black fungus cases treated?
After infecting a person, the fungus doesn't remain static but spreads through the nose, attacks the eyes, and eventually reaches the brain, at which point it becomes potentially deadly. This necessitates multi-discipline expertise to treat it.

In a majority of cases, especially if undetected for long, a number of different parts end up getting affected by mucormycosis. So it calls for a combined team of microbiologists, internal medicine specialists, intensivist neurologists, ENT specialists, ophthalmologists, dentists, surgeons, etc.

As part of life-saving procedures, all infected tissues have to be surgically removed. Some patients end up losing the eye/s and, in some cases, the upper jaw.

Patients might need an intravenous anti-fungal procedure spanning four to six weeks.

How risky is this condition?
The fatality rate in mucormycosis cases is very high.

As per data available thus far, mortality is as high as 80% if a patient goes untreated, or remains untreated long. If treated, it is still 40-50%. In cases where the infection is caught at the sinus stage itself, patients mostly completely recover.

Besides, according to doctors, drugs used for treating this condition come with strong side effects. That can, in some cases, lead to "kidney issues, neurological dysfunction and stroke".

Drugs being used in the treatment
Doctors are currently using Liposomal Amphotericin B for treating black fungus infections. As many as 20 vials of this injection are required to treat each infected person. According to reports, each vial currently costs between Rs 5,000 and Rs 6,000.

The availability situation for this medicine is currently alarming because its supply is controlled by the government. In its absence, some doctors have said they've moved to second-line drugs like Posaconazole.

Self-medication is a strict no-no and black fungus medicines must only be used under prescription and medical supervision, say doctors. Also, one must watch out for the over-dosage of steroids, they warn.

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