Monday, June 21, 2021

Cases of Covid-linked mucormycosis reported across India

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Hospitals across India have been reporting cases of Covid-linked mucormycosis or black fungus, a rare infection, with deaths of it reported from Jabalpur in Madhya Pradesh and Thane in Maharashtra.

On Monday, Odisha reported its first case of mucormycosis while Delhi, Gujarat and Uttar Pradesh, and Rajasthan have also detected its cases. New Delhi’s All India Institute of Medical Sciences has created a separate ward to treat black fungus patients.

Mucormycosis affects the sinuses, the brain, and the lungs and can be life-threatening in diabetic or severely immune-compromised individuals such as cancer patients or people with HIV/AIDS. Symptoms of mucormycosis include headache, fever, pain under the eyes, nasal or sinus congestion, and partial loss of vision. Some may even experience coughing, shortness of breath, bloody vomits, and altered mental status, doctors said.

Doctors believe mucormycosis, which has an overall mortality rate of 50%, maybe being triggered by the use of steroids, which are life-saving drugs for severe and critically ill Covid-19 patients.

Steroids reduce inflammation in the lungs in Covid-19 cases and appear to help stop some of the damage that can happen when the body’s immune system goes into overdrive to fight off coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients. The reduction in immunity can cause mucormycosis, doctors said.

In Jabalpur, three deaths of mucormycosis have been reported since May 1. About 10 people have lost vision while 40 others are undergoing treatment in Bhopal, Indore, Khandwa, Jabalpur, and Gwalior, said a state health official.

State medical education minister Vishwas Sarang announced that separate wards will be set up for the patients infected with black fungus. “Mucormycosis units will be set up at medical colleges in Bhopal and Jabalpur for surgery of infected patients,” Sarang said.

On Wednesday, Thane district in Maharashtra reported two more deaths caused by the black fungus. Six other patients in Thane are undergoing treatment for the infection, officials said.

Health minister Rajesh Tope said that the state could have as many as 2,000 cases of mucormycosis and the government has decided to use hospitals attached to medical colleges such as King Edward Memorial (KEM), Parel and BYL Nair Hospital, Mumbai Central as treatment centres for the disease.

As many as 14 cases of black fungus have been reported from Jaipur in Rajasthan. . Mohnish Grover, head of the ENT department at Sawai Madho Singh (SMS) hospital, said last year from August to December around 24 cases were reported of black fungus.

“Before Covid-19, one or two cases were reported in a year. But during the second wave of Corona, the cases are exploding; now 2-3 cases are coming daily at SMS,” he said, adding that earlier the mortality rate was 30%-50%, which has now come down to 10%. He added in the present wave more people are losing their vision.

At least 70 cases of mucormycosis have been detected in Hyderabad in the last month and at least six patients died of it in the last few weeks. In Apollo Hospitals, around 50 such cases were reported and the remaining at two other corporate hospitals. “At present, there are 10 cases being treated at Apollo Hospitals and all of them are in critical condition,” said Dr K Subba Reddy, head of critical care, Apollo Hospitals. The patients have been isolated and given treatment with extreme care, he said.

Doctors at SLG Hospitals, Hyderabad, on Wednesday claimed to have saved the lives of three patients suffering from black fungus. “Three patients, aged 25, 42, and 63 years, who recently recovered from Covid-19, reported nasal obstruction and eye-sight related complaints. Large traces of mucormycosis were found in their nasal cavity and it required a surgical procedure to treat them,” said Dr Bhargaw Ilapakurty, consultant head and neck surgeon at the hospital.

In Odisha, the throat swab of a 71-year-old man taken on April 18 came positive for the infection on Monday. On May 8, his eyes swelled, and he reported blackish discharge from his nose. After nasal endoscopy, it was found he has some black deposits on the turbinate.

“The patient’s sample suggested fungal hyphae and the culture showed Rhizopus (mucorale). The infection was during the Covid home isolation,” a government official said. He added the man had uncontrolled diabetes.

Chhattisgarh health department officials said 15 cases of black fungus infection have been reported in the state and all patients are admitted to AIIMS (Raipur). “Most of these black fungus infection cases are because of an overdose of steroids. The early treatment is advisable because, in later stages, it hits the eyes of the patients,” said a health official.

In the past month or so, as many as 100 cases of black fungus have been reported from Gujarat, after which the state government has set up separate wards in hospitals for such patients. Officials said in some cases people have lost their vision also.

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As the cases have increased, the union health ministry has decided to increase the production of anti-fungal injection Amphotericin B used to treat patients suffering from mucormycosis.

Supply of the medicine is expected to improve with extra imports and an increase in domestic production, the ministry has said in the advisory. The ministry has asked states to create awareness about black fungus.

“The hospitals have been asked to use filtered water in an oxy-flow meter. Similarly, ICUs should be sanitised properly. With discharge papers, the hospitals should provide a pamphlet of mucormycosis related to symptoms, cure, and preventive measures,” the health ministry said in its advisory.

Maharashtra health department has requested the National Pharmaceutical Pricing Authority to put a cap on the prices of Amphotericin B that costs between 5,000 and 8,000. A tender has been floated for the procurement of 10,00,00 doses of the antifungal injection, Tope said.

On Friday, Niti Aayog Member (Health) V K Paul said mucormycosis cases were being found in coronavirus patients and cases have been reported from several states. He said that states have been advised to create awareness about the fungal infection.

(With inputs from state bureaus and agencies)

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