As the debilitating second wave of the Coronavirus pandemic slowly subsides from its peak, a rare infection known as black fungus is creating panic in our country. India has reported more than 12,000 cases with the Centre directing all states to declare it a notifiable disease. It has created a lot of fear among people, as the reported mortality is 50% with many surviving only after having one of their eyes removed. What is causing this infection? Who risks contracting it and how can it be cured? Why are there so many cases suddenly while it was termed as a rare infection?
WHAT IS FUNGUS?
According to Encyclopedia Britannica, fungi (plural of fungus) are a known species of organisms of the kingdom Fungi, which includes yeasts, rusts, smuts, mildews, molds, and mushrooms. Fungi are eukaryotic organisms; i.e., their cells contain membrane-bound organelles and clearly defined nuclei.
Historically, fungi were included in the plant kingdom; however, because fungi lack chlorophyll and are distinguished by unique structural and physiological features (i.e., components of the cell wall and cell membrane), they have been separated from plants.
In addition, fungi are clearly distinguished from all other living organisms, including animals, by their principal modes of vegetative growth and nutrient intake. They have long been used as a direct source of human food, in the form of mushrooms and truffles; as a leavening agent for bread; and in the fermentation of various food products, such as soy sauce. Fungi have been used for the production of antibiotics, and, more recently, various enzymes produced by fungi are used industrially and in detergents.
WHAT IS BLACK FUNGUS?
Currently, the term black fungus has become popular to describe a fungal disease known as mucormycosis. It is caused by exposure to a type of fungus – mucormycetes /mucor mould, which is commonly found in soil, plants, manure, decaying fruits and vegetables and even in the nose and mucus of humans.
HOW CAN ONE BE INFECTED?
It is mainly attacking Covid patients. One can be infected with mucormycosis after inhaling the spores of the fungi or through a skin injury or even after consuming mucormycetes through regular food. One more reason for being infected was frequently discussed in the media. It is said that dirty oxygen cylinders and ventilators were behind the growing incidence of black fungus in India.
According to medical experts, there is a high amount of contamination in the pipes and cylinders being used for oxygen. Even humidifiers could cause infection.
Some suspect that the kind of oxygen delivered to patients in India could also have played a role. In the oxygen crisis that we experienced recently, a huge amount of industrial oxygen was utilised to tide over the shortage of medical oxygen. Industrial oxygen does not pass through as many filters of purification as medical oxygen. Hence, it has more contaminants and it could have resulted in infecting patients with the deadly fungi.
WHY IS IT SO DANGEROUS?
First, it is extremely difficult to detect and cure. The fungus is quite stealthy and resistant to the body’s immune system. The symptoms that people infected with black fungus exhibit are quite generic and if it is not detected quickly, the results can be quite damaging. The infection is very aggressive and affects the nose, eye and even the brain and lungs.
WHAT ARE SOME OF THE SYMPTOMS?
Those who contract mucormycosis typically exhibit symptoms like fever, one-sided facial swelling, headache, nasal or sinus congestion, black lesions on nasal bridge or upper inside of mouth that quickly become more severe. Patients may experience drooping of eyelids, initially blurred and later a complete loss of vision.
PROBABILITY OF INFECTION
Those who are most likely to contract the disease include: a) patients who are immunocompromised; b) those with uncontrolled diabetes; c) who have HIV/AIDS; d) who have recovered from Covid since the past 6 weeks; and e) patients with kidney disorders. There could be another reason for the high incidence of black fungus in the second wave.
DETECTION AND USE OF STEROIDS
Fortunately, the healthcare fraternity of our country is second to none and hence knowledge and awareness about mucormycosis/black fungus was never an issue.
According to an article in the popular science magazine, Scientific American (Why Deadly ‘Black Fungus’ Is Ravaging COVID Patients in India by Maryn McKenna on May 28, 2021) – “Identifying a case of mucormycosis early can be challenging. Unlike some other fungal infections, there are no blood-based tests that can detect it. Diagnosis requires doing a biopsy, examining the sample and sometimes following up with a CT scan – all of which imply the availability of specialty personnel to perform those tasks and advanced equipment to support them. In the under-resourced parts of India’s vast health care system, those cannot be guaranteed.”
The same article also discusses the excessive use of steroids as one of the possible causes of the disease. It says: “A standard component of treatment for severe cases of Covid is high doses of corticosteroids, anti-inflammatory drugs that damp down the immune system’s overreaction to infection. Steroids save lives, but they simultaneously make a patient more vulnerable to attack by whatever bacteria or fungi are already in their body or hanging around their environment.”
HOW IS BLACK FUNGUS TREATED?
The patients are administered antifungals through intravenous infusion and the therapy may require weeks of hospitalisation as it requires close monitoring of the kidney function. Amphotericin B is the most commonly used anti-fungal medication being currently deployed and is in great demand. The Liposomal Amphotericin B has the best quality with minimum side effects and hence very expensive. Based on the impact of the infection, the treatment may also entail jaw removal or eye surgery.