Covid-19: A potentially deadly ‘black fungus’ infection seen in patients in India

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  • A rare fungal infection is on the rise in vulnerable Covid patients in India
  • The 'black fungus' infection has been found in patients in a number of cities in the country
  • Treatment for the condition is available, but costly

As India continues to battle an unprecedented Covid-19 outbreak, doctors in the country are witnessing some Covid patients developing a rare and potentially deadly fungal infection that can invade the brain.

Known as "black fungus" and medically termed mucormycosis, the infection is caused by a group of moulds called mucormycetes, which live throughout the environment, including in soil, decaying fruits and vegetables, and on plants, notes the US Centers for Disease Control and Prevention (CDC).

It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air, but it can also enter the body through the skin after a cut, burn, or types of skin injury. Once the fungus makes its way into the body, it can spread through the bloodstream and affect other organs including the eyes, spleen, heart, and brain.

According to the CDC, mucormycosis can be acquired in hospitals when the moulds get onto hospital linens, travel through ventilation systems, non-sterile medical devices, or are transmitted on adhesives.

“They’re a family of fungi that get into your sinuses and deposit there, and they can get into the air spaces in your head,” Professor  Peter Collignon, who sits on the World Health Organization’s expert committee on antibiotic resistance and infectious diseases, told The Guardian

“And when your immune system can’t keep them under control they invade the base of your brain where it becomes a real problem, and is really very serious,” he added.

How common is it?

The condition is very rare – around 500 cases a year were estimated to occur in the US prior to the Covid pandemic, indicates the CDC. 

Approximately 113 cases occur annually in South Africa, according to a 2019 report published in the South African Medical Journal

Who does it mainly affect?

The condition commonly affects people with underlying medical conditions, including those with diabetes, as well as those taking medications that suppress the body's immunity.

Cases in India

Although mucormycosis is seen throughout the world, an increasing number of Covid patients in India appear to be contracting the infection, The New York Times reported.

According to The Times, citing local news reports, in the western state of Maharashtra (capital Mumbai), 200 Covid patients who had recovered from the disease were being treated for mucormycosis. 

Infections have also been reported in hospitals in New Delhi (capital of India) as well as the state of Gujarat.

"We have heard that in some areas, people who are Covid-infected or recovered suffer from mucormycosis, but there is not a big outbreak of it," Dr V.K. Paul, head of India's Covid task force, said at a press conference last week, The Times reported. "We are watching and monitoring," he added.

The typical symptoms of mucormycosis seen in the Covid patients include a stuffy and bleeding nose; swelling of and pain in the eye; drooping of eyelids; and blurred sight and loss of vision. Black lesions can also appear around the nose, BBC News reported. 

Why is it happening?

Doctors believe the fungal infection may be triggered by the use of steroids in hospitalised Covid patients, which is a life-saving treatment for them, according to BBC News. 

The article explains that while high doses of these steroids are helpful in reducing inflammation in Covid patients who end up in intensive care, they can, unfortunately, also suppress your immune system and increase blood sugar levels in both diabetics and non-diabetic Covid patients – which can then trigger mucormycosis.

Those with diabetes, for example, already have an increased risk of the fungal infection, even before taking steroids. "Diabetes lowers the body's immune defence, coronavirus exacerbates it, and then steroids which help fight Covid-19 act like fuel to the fire," Dr Akshay Nair, a Mumbai-based eye surgeon, told BBC News.

Patients affected

Nair, who works in three hospitals in Mumbai, told BBC News that he saw 40 patients suffering from mucormycosis in April. Many of them were diabetics, he said, who had recovered from Covid at home. Unfortunately, eleven of them had to have an eye surgically removed.

Between December 2020 and February 2021, Nair's colleagues reported 58 cases of the infection across five cities in India. Most of the patients contracted it between 12 to 15 days after recovery from Covid infection.

Mumbai's Sion Hospital, which generally sees around six cases a year has already reported 24 cases of the fungal infection in the past two months, Dr Renuka Bradoo, head of the hospital's ear, nose and throat wing told the news publication.

Eleven of these patients had to have an eye surgically removed, while six died. The condition has a high mortality rate of 50%.

Treatment available, but costly

An anti-fungal treatment is available, but costs 3 500 rupees (around R660) a dose and has to be administered every day for up to eight weeks, notes BBC News. It is the only drug effective against mucormycosis.

Collignon told The Guardian: “You invariably need surgery as well to clear out the source of the fungus, which is usually the sinus, and the back of your throat at the back of your nose,” he said, adding:  “You’ve got to get in there and cut out all of the fungal material. That surgery can be in very delicate places like the base of your brain.”

However, Dr Rahul Baxi, a Mumbai-based diabetologist, told BBC News that the possibility of contracting the infection can be stalled if doctors ensure that Covid patients, who are both in treatment and have recovered, are given the right dose and duration of steroids.

According to Baxi who treated roughly 800 diabetic Covid patients in the past year, none of them contracted mucormycosis. "Doctors should take care of sugar levels after the patients are discharged," he said.

The Indian Health Ministry has published an advisory urging people to wear shoes and clothing items that cover their legs, arms, and hands while handling soil, moss or manure. Moreover, they said, people should maintain personal hygiene, and ensure that those living with diabetes have the condition under control. Finally, they advised that medical professionals should discontinue immune-suppressing drugs such as steroids as soon as possible. 

*For more Covid-19 research, science and news, click here.

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