In recent weeks, thousands of cases of black fungus have been reported across the country, with hundreds hospitalized and at least 90 dead. Two states have declared it an epidemic and the central government has made it a notifiable disease.
This is what we know about the black fungus and its spread in India.
Black fungus is caused by molds found in humid environments such as soil or compost, and can attack the airways. It is not contagious and does not spread from person to person.
Various types of fungi can cause the disease. These fungi are not harmful to most people, but they can cause serious infections among those with a weakened immune system, according to the U.S. Centers for Disease Control and Prevention (CDC).
The black fungus usually affects the sinuses or lungs after a person inhales fungal spores into the air and can also affect the skin after a superficial injury such as a cut or burn. Symptoms depend on where the fungus grows on the body, but may include facial swelling, fever, skin ulcers, and black lesions in the mouth.
The disease “begins to manifest itself as an infection of the skin in the air sacs located behind the forehead, nose, cheekbones and between the eyes and teeth,” the Indian Ministry of Health said in a statement on May 14th. “It then spreads to the eyes, lungs and can even spread to the brain. It leads to blackening or discoloration of the nose, blurred or double vision, chest pain, difficulty breathing and coughing up blood.”
“One of the ways mucormycosis travels is to invade blood vessels,” Dr. Hemant Thacker, consulting physician and cardiometabolic specialist at Breach Candy Hospital in Bombay. “It compromises the circulation to the distal organ and therefore produces what is called tissue necrosis or death, which then turns black. Hence, it is called black fungus.”
In more severe cases, the infection “passes through the blood vessels to the brain,” potentially causing vision loss or creating an “open hole” in the face, he added. “If it’s not controlled, it’s not treated, it can have a mortality (rate) of between 20% and 50%.”
A 2005 study of 929 cases dating back to 1885 found an overall mortality rate of 54%, according to the CDC. The mortality rate also depends on the type of fungus involved and which part of the body is affected. For example, it is less deadly for people with sinus infections, but more deadly for people with lung infections.
What is the link to Covid-19?
Immunocompromised people are more susceptible to infection, including patients with Covid-19, diabetic patients, people taking steroids, and those with other comorbidities such as cancer or organ transplants, the Ministry of Health said. ‘India.
Covid patients are particularly susceptible because the virus not only affects their immune system, but medications for treatment can also suppress their immune response. “Because of these factors, COVID-19 patients face a renewed risk of failing in the battle against attacks produced by organisms such as mucormycetes,” the ministry said, referring to the fungi that cause mucormycosis.
Covid patients undergoing oxygen therapy in the ICU may have humidifiers in the room, which may increase their exposure to moisture and make them more prone to fungal infection, the ministry said.
“The fungus takes advantage of the window of opportunity, it invades the body,” Thacker said. “This body has a small opening because of Covid, because of the sugars (high glucose levels), because of the antibiotics, because of so many other things, (the black fungus) has a fulcrum.”
The ministry warned that “this does not mean that all Covid patients become infected with mucormycosis,” as it is uncommon among those without diabetes.
According to India’s national health portal, the prevalence of diabetes in the country is 12% to 18% of the adult population, especially in urban areas.
“India is the diabetic capital of the world,” Thacker of Breach Candy Hospital said. “We have tropical climates where the fungus is destroyed. So all of this has caused the black fungus epidemic.”
How do you treat him?
According to the CDC, black fungus is treated with antifungal drugs, often administered intravenously. The most common medications include amphotericin B, a drug currently used in the states of India to combat the outbreak.
Patients may need up to six weeks of antifungal medications to recover. Its recovery depends on the early diagnosis and treatment of the disease.
Surgery is often required to cut dead or infected tissue. “In some patients, this can lead to loss of the upper jaw or sometimes even the eye,” the Indian Ministry of Health said in a statement.
Demand for amphotericin B is increasing in India, but it is scarce as hospitals had not anticipated the number of cases.
Bhavya Reddy, a resident of eastern Telangana in southern India, said his father was diagnosed with black fungus on April 26, just as he was recovering from Covid-19.
“Once he started recovering (from Covid) his face started to swell,” Reddy said. “When the swelling didn’t go down, (the doctors) told us we would get the injection.” The hospital had no supply of amphotericin B and had to appeal to the chief minister of the state to receive vials of the drug, he said.
Once the drug was secured, her father underwent endoscopic breast surgery to relieve the inflammation.
Mansukh Mandaviya, junior minister of the Ministry of Chemicals and Fertilizers, tweeted on Thursday adding that five companies have been approved to produce the drug in India, in addition to six existing ones.
How common is it?
The disease is distributed worldwide and is generally quite rare, although it can be difficult to establish accurate estimates of its prevalence due to lack of surveillance and exhaustive data.
In the United States, laboratory surveillance in the San Francisco Bay Area between 1992 and 1993 suggested an annual rate of 1.7 cases per million people, according to the CDC.
However, the disease seems to be more common in India; a study by Indian microbiologists, published in March in the journal Microorganisms, suggested that the black fungus is 70 times more prevalent in India than in global data.
There are several possible reasons why there is a higher rate of “uncontrolled diabetes” in India, according to the study. Many patients who studied did not even know they had diabetes until they were diagnosed with a black fungus, which demonstrated “the lack of periodic health check-ups in the Indian population,” the study said.
The black fungal mortality rate in India is also “considerably high due to delays in seeking medical attention and diagnosing the disease, and challenges in managing the advanced stage of infection,” he said. said the study.
The country’s climate is also a factor, Thacker said. “This fungus can grow next to a loaf of bread that is kept outside,” he said. “It can grow anywhere in the form of mold, but in humid tropical countries … it tends to sink.”
The current outbreak could also be because “we’re in the summer, it’s hot, it’s humid,” he added. “Everyone knows that fungal infection occurs in these types of climates.”
Where has it been reported?
To date, more than 3,200 cases of black fungus have been reported in the five states of Maharashtra, Madhya Pradesh, Haryana, Telangana and Gujarat.
Maharashtra has the highest number, with more than 2,000 cases reported and 800 hospitalized. At least 90 people have died from the disease in the state.
Gujarat has reported at least 369 cases in a single hospital.
On Thursday, the central government classified mucormycosis as a notifiable disease, meaning all states and territories in the union must report their cases to federal authorities.
“We now have a new black mushroom challenge, we need to be prudent and prepare to do so,” Indian Prime Minister Narendra Modi said on Friday.
At least seven states have stated that black fungus is a notifiable disease, according to central government advice to collect data, according to the respective state government authorities.
“These cases are found in patients who have recovered from Covid, so there are several complications,” said JV Modi, medical superintendent at Ahmedabad Civil Hospital in Gujarat. He added that the hospital has seen an increase in cases in the last ten days as the country appeared to be surpassing the peak of its second wave of coronavirus.