What is mucormycosis ‘black fungus’? Does Maldives have it?

A relative of a person who died of COVID-19 is consoled by another during cremation in Jammu, India, Sunday, April 25, 2021. Delhi has been cremating so many bodies of coronavirus victims that authorities are getting requests to start cutting down trees in city parks, as a second record surge has brought India's tattered healthcare system to its knees | Photo: Channi Anand via Aljazeer

Malé, Maldives – Spokesperson of the President’s Office Mabrook Azeez confirmed that the Maldivian patient who was suspected to have mucormycosis has tested negative for the fungal infection.

He stated that although the patient was suspected to have the disease, the test samples showed that it was not mucormycosis causing the symptoms. The symptoms were found in an old aged man who consulted a doctor at IGMH. He was suspected to have the disease which is why his sample was sent for further testing.

Before the sample of the suspected patient was confirmed to have tested negative for the disease, pediatrician Dr. Faisal said that currently, there is no medicine for mucormycosis in Maldives. Tagging the Twitter handle of State Trading Organisation (STO) Dr. Faisal tweeted that medicine for this lethal infection need to be imported to Maldives as there are no current medications available in the country. He noted that these medications are scarce in India as well which is recording several cases of the infection.

Dr. Faisal also stated that people having diseases such as cancer and people using steroids have a higher chance of getting the disease as they have a weakened immune system. He added that although testing for the disease is not currently available in Maldives, patients can be treated according to their symptoms if the necessary medications are available.

While the disease is a lethal infection, Dr. Mauroof said that this disease does not spread from person to person but is rather cause by a species of fungi in people with a weakened immune system, presumably due to a underlying condition or the use of steroids.

Mucormycisis in India

This rare fungal infection, mucormycosis is currently spreading at a fast pace in neighbouring country India. The two states of India, Maharashtra and Gujarat are currently at the top for this disease. Reports show that some patient who consult the doctor due to symptoms have already lost their sight and some have had to remove their eye ball altogether.

State after state is reporting a daily high in cases of mucormycosis, which can be fatal, among patients recovering from coronavirus.

In Haryana, the count has risen to 421 while the infection is on a rise among COVID-19 patients in Andhra Pradesh, Assam, Bihar, Delhi, Gujarat, Karnataka, Madhya Pradesh, Kerala, West Bengal, Himachal Pradesh, Uttar Pradesh and Uttarakhand as well.

The Delhi government-run Lok Nayak Jai Prakash Narayan (LNJP) and Guru Teg Bahadur (GTB) hospitals reported 36 more cases of black fungus in a day, according to senior officials on May 23rd. India used to record about 100 cases of black fungus a year earlier but now Karnataka alone has recorded about 700 cases last week, Deputy Chief Minister CN Ashwath Narayan, who is also the head of the state’s COVID task force stated.

What is mucormycosis? How is it caused?

Mucormycosis is a very rare fungal infection. It is caused by exposure to mucor mould which is commonly found in soil, plants, manure, and decaying fruits and vegetables. It affects the sinuses, the brain and the lungs and can be life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS.

Sinuses or lungs of such individuals get affected after they inhale fungal spores from the air. Doctors in some states have noted a rise in cases of mucormycosis among people hospitalized or recovering from Covid 19, with some requiring urgent surgery.

What are the symptoms?

Symptoms of the disease include pain and redness around the eyes or nose, with fever, headache, coughing, shortness of breath, bloody vomits, and altered mental status. According to the advisory, infection with mucormycetes should be suspected when there is:

  • Sinusitis — nasal blockade or congestion, nasal discharge (blackish/bloody)
  • Local pain on the cheek bone, one-sided facial pain, numbness or swelling
  • Blackish discoloration over bridge of nose/palate
  • Loosening of teeth, jaw involvement
  • Blurred or double vision with pain
  • Thrombosis, necrosis, skin lesion
  • Chest pain, pleural effusion, worsening of respiratory symptoms.

Are you at risk?

Doctors believe mucormycosis, which has an overall mortality rate of 50%, might be triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients. Steroids reduce inflammation in the lungs for Covid-19 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. It’s thought that this drop in immunity could be triggering these cases of mucormycosis.

People with a healthy immune system are not at danger due to this disease as the infection is found in people with a compromised immune system due to several other reasons. Covid-19 patients are more susceptible to the disease as their immune systems have been weakened by the virus giving a chance for the fungal infection to settle in.

What is the treatment for the disease?

While it is treated with antifungals, mucormycosis may eventually require surgery. Doctors have said that it is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs. To maintain adequate systemic hydration, the treatment includes infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks. Some people end up losing the upper jaw or more commonly their vision sometimes having to remove the eyeball. Some patients currently undergoing this have endured these consequences.

Is there an outbreak in India?

While cases are on the rise, authorities state that there is no major outbreak. Niti Aayog member (health) Dr V K Paul said at a media briefing that there has been no major outbreak and they were monitoring cases being reported. Several health experts stress that not everyone is prone to the disease and that people with underlying conditions are at risk.