The black fungus outbreak in India

Fareeha Arshad

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With the second wave of the deadly coronavirus, India is still struggling with the rising number of cases and another fungal epidemic hit with over 12,000 diagnosed cases within few days. Also called the ‘black fungus’, it has been known to cause an infection called ‘mucormycosis’ that has seen a rise among the patients affected or recovering from COVID-19.

Despite being a relatively uncommon condition, it has a mortality rate of 54% among the infected individuals, as per the US Centers for Disease Control and Prevention data. Previously, the country has shown to have as few as twenty mucormycosis infection cases a year. With almost compromised health systems in India, overcrowded environments and cramped spaces have allowed this fungus to spread rapidly.

How does the black fungus cause the infection?

Also called the black fungus, mucormycetes are groups of moulds commonly found in the environment. They are also found especially in the soil and plants and all across the world. This fungus causes mucormycosis infection.

In an unclean environment, these moulds get transported into the hospitals via ventilation systems. When we breathe these particles, they get deposited in our sinuses and travel into the air spaces in the head. When the immune system is weak or compromised, it rapidly spreads towards the brain when the condition worsens.

This sudden rise in mucormycosis has been noted more among COVID-19 patients being treated with steroids. Overuse of steroids for prolonged periods causes the malfunction of the immune system. Instances of prior diabetes conditions may also increase the chances of acquiring this fungal infection. Other immunocompromised individuals like cancer patients or people suffering from HIV/AIDS are also more likely to acquire this infection.

The rates of this infection have been noted to be the highest in intensive care units where the airways have a significantly increased amount of humidity and moisture that contributes to the fungal growth. Balram Bhargava, the director of the Indian Council of Medical Research, told The Guardian,

“If a person’s immunity is suppressed, it will infect them. If the spores have access to high sugar [levels], it will grow. We have seen this happen with Covid-19 patients with diabetes and uncontrolled sugar, or who are immunocompromised or have been given immune-suppressants.”

The only silver lining in the bleak future is that this disease is not contagious. That is, it won’t spread on contact with infected individuals. The rapid spread is achieved only by direct contact with the fungal spore. Sometimes, these spores are already found within our body, like the mucous lining of our nose. However, our body's immune system is strong enough to fight these off. But a weak immune system? Not so much.

The first signs of infection and possible treatment options

The first visible signs of the infection are the discolouration of the nose and breathing difficulties. When the infection spreads into the brain, the condition becomes critical, and the patient starts coughing out blood. Often the disease becomes so complicated that the only choice of treatment that remains is major surgery like removing eyes or a part of the skull or the jaw to stop the rapid spread of the infection.

To treat the initial stages of mucormycosis, an anti-fungal intravenous injection, Amphotericin B, is administered daily for eight weeks. This drug is available either as standard amphotericin B deoxycholate or liposomal amphotericin.

Why this sudden outbreak and what it means for the rest of the world?

The COVID-19 is known to be linked to secondary bacterial and fungal infections. However, the current treatment conditions and environmental factors, especially in India, have paved the way for the virus to grow and spread.

A high number of patients with low oxygen levels increased numbers of diabetic patients, and patients with compromised immune systems are some of the major factors why this fungus is spreading at an ever-increasing rate. External conditions like prolonged hospitalization of coronavirus patients on ventilator machines and unhygienic hospital conditions are also responsible for contracting mucormycosis.

The best-case scenario?

We can put a plug on the rapid spread of coronavirus and provide a sterile environment for the immunocompromised COVID-19 patients at the hospital.

The worst-case scenario?

We may have another pandemic to deal with.

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I am a scientist by profession and a historian by passion. I write about current affairs, history, science, and lifestyle.

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