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India: Last week, the doctors at Delhi’s Sir Ganga Ram Hospital (SGRH) were treating 13 Covid-19 patients who were on the path of recovery. Subsequently, they got diagnosed with mucormycosis, a fungal infection that can prove lethal in individuals with underlying health conditions, and soon, nearly half of them reported loss of vision. Some of them had had their nose bones and jaw bones removed and five of those patients died.
Another hospital- Apollo, at Indraprastha, New Delhi, reported three deaths among seven of its cases. Similarly, Max Superspeciality, Delhi, which has seen 24 such cases since the pandemic, had 20 of its patients lose their eyesight with one dead. Sanjay Sachdeva, Principal Director of ENT at Max, observes that Covid-19 has made the fungal infection more aggressive and his patients are losing their eyesight, sense of smell and other bodily functions within just two days.
In the western state of Gujarat, nine out of 46 patients died from Mucormycosis infection. Dr. Devang Gupta from the Civil Hospital says, “In the past I would see 20 cases in 18 years. Now I have 46 cases in nine months. We have recorded 20 per cent mortality rate. Mostly the patients are with lower immunity after their recovery from Covid-19.”
Mucormycosis infection cases are now being registered at Rajkot, Gujarat, as well. The city of Mumbai, Maharashtra, also had its three cases, all from Jaslok Hospital and Research Centre.
The rapid increase in infection among those who are recovering from Covid-19 is a serious cause for concern. Bhiya Ram, Asst. Prof. at All India Institute of Medical Sciences (AIIMS), puts the fatality rate for such patients at 80 per cent. The state of Gujarat has put this figure at 50 per cent.
An alert for this disease has been issued in Mumbai and Ahmedabad by the authorities. India has also recently banned all flights coming from the U.K. to curb the spread of the new Covid-19 virus strain.
What is Mucormycosis?
Mucormycosis is a serious but rare infection caused by a group of molds called mucormycetes. It is also known as zygomycosis. This fungus is omnipresent- it’s in the air, water, soil, etc. Its fungal spores enter the body through inhalation or seep through the skin where there is a cut, burn or an open wound.
This infection is angioinvasive (that is, it infiltrates the blood vessels.) Once it affects the blood vessels, it causes death in the tissues in which it stops the supply of blood. The patient experiences an aggressive infection which requires timely medical intervention.
Commonly, it affects the sinuses or the lungs, but it can attack and damage any part of the body, including the brain. It is more likely to infect those who have an underlying health condition or have low body immunity.
The link between Covid-19 and Mucormycosis-
The weak immune system of the Covid-19 patients, according to experts, makes them susceptible to catch this fungal infection. Many of these patients have been administered strong drugs like antiviral and steroids that weaken the body’s immune system.
How does Mucormycosis spread?
- Fungus is present everywhere; even in soil and air. It can enter through skin pores, skin burns, cuts and abrasions on the body
- Mostly it is contracted through inhalation of the air
- It can enter any part of the body but is mostly found in sinuses and lungs
- Mucormycosis does not spread from person to person or from an animal to person. It is only contracted through fungal spores in the environment
What are the symptoms of Mucormycosis?
- One side swelling on the face, or swelling in the eyes, numbness of the cheeks
- Fever, headache, cough, chest pain, shortness of breath
- Nasal or sinus congestion. Black or purple lesions/ crusts on nasal bridge, inside the nostrils or roof of the mouth
- Blisters or ulcers in any part of the body. Black or purple spots on the body
- Abdominal pain, vomiting or gastrointestinal bleeding
How does Mucormycosis damage a body?
- It kills the tissues of that part of the body where it is lodged
- If it is in the sinus, then removal of the nose bone and jaw bone
- If it has moved to the brain (rhino-orbito-cerebral Mucormycosis (ROCM)) then a cerebral surgery is needed. It may lead to memory loss
- If it is in the eyes, then loss of eyesight. The patient may have to undergo an evisceration (disembowelment of the eye)
- It can lead to an organ failure or even result in death in the process of surgical removal of the damaged tissue
What treatments are available for Mucormycosis?
Time is of the essence in its treatment. Symptoms like pressure in the eyes or numbness in the cheeks should be taken seriously and immediately checked by a doctor. An early detection through endoscopy can reveal color of the spots inside the nose (black and purple in this case).
Antifungal therapy along with surgery on the affected body part is usually performed.
Who is at risk?
- Immunocompromised patients, individuals with low WBC count and people suffering from diabetes, HIV, cancer and Covid-19. Patients receiving steroids and individuals who have been immunodeficient in the past are also vulnerable
- People who have undergone surgery for an organ transplant, stem cell transplant, kidney failure and those who have been in the ICU
- People with too much iron in their body
- People who are old and therefore, low on immunity
- People who have an underlying health condition
What precautions must one take?
- Avoid contact with dust and fungus. Cover your body outdoors to avoid seepage through the skin pores- wear socks, shoes, long pants, long sleeves shirt and gloves. Avoid activities like gardening.
- If you have any cuts/ open wounds on your body, wash and cover them.
- Wear a face mask, N95 preferably
- If you are on steroids, check with your doctor to increase its dose
- Make efforts to boost your immune system. Eat healthily and exercise.
- Keep your house clean to prevent dust from collecting
- Check for excess iron level in your body and consult your doctor as required