AS INDIA IS STRUGGLING with the second Covid-19 wave, it is facing another challenge in the form of mucormycosis, commonly known as Black Fungus. In the last few months, there has been a sharp rise in the number of fungal infections reported in India. The disease has been declared an epidemic in various states. The rare infection, called mucormycosis, has a mortality rate of 50%. Health experts predict around 1,750 to 2,500 cases of mucormycosis daily in India. Dr. Alkesh Chaudhary, Ophthalmologist/Eye Surgeon, MD Eye Care, and Laser Centre, Delhi, tells MADIHA RAZA that the rise in the number of Black Fungus cases this time is mainly because of unrestricted use of steroids. The infection is triggered by excessive use of steroids. Covid-19 patients are treated with heavy steroids and drugs like Tocilizumab that reduce the immune system of the body. This drop-in immunity triggers these cases of mucormycosis.
DR ALKESH CHAUDHARY, 58 YEARS
EDITED EXCERPTS FROM AN INTERVIEW
What is mucormycosis? Who can get it and why is it now common in Covid-19 patients?
Mucormycosis is a fungal infection which is now very common in Covid-19 patients. It is caused by exposure to mucor mold which is commonly found in the soil, plants, manure, decaying fruits and vegetables. It is ubiquitous and found in soil and air and even in the nose and mucus of healthy people.
It affects the sinuses, brain and lungs and can be life-threatening in diabetic or severely immune-compromised individuals such as cancer patients or people with HIV/AIDS.
It is triggered by excessive use of steroids, which is the only life-saving treatment for Covid-19 patients. Covid-19 patients are on heavy steroids and drugs like Tocilizumab that reduce the immune system of the body. If the immune system is depressed then this fungal infection can occur in your body rapidly and can proliferate to the lungs and brain. This drop-in immunity triggers these cases of mucormycosis.
Because of the amid surge in black fungus cases, The governments of various states of the country declared it an epidemic. Why are the cases rising rapidly, particularly in India?
In India people are taking medical treatment erratically. During this time, most of the patients self-medicate with steroids without consulting doctors. Also, people are consuming heavy steroids without controlling their sugar levels.
People who are immunocompromised like diabetic patients, whose sugar levels are high and not well controlled. If such critical Covid-19 patients are treated with heavy steroids, they are put at high risk of fungal infection. High sugar is the basic risk for developing mucormycosis. You will find black fungus usually in those cases that are treated erratically.
According to the experts, the infection (mucormycosis) is rare and impacts patients who have recovered from the Coronavirus infection. But once a person gets infected the fungus manifests in the skin or can affect the brain or lungs? How can it be treated and what are the preventive measures?
Yes, mucormycosis is a rare infection that happens in coronavirus patients because of erratic treatment, because of the steroids and heavy drugs, which leads to depression in your immune system and causes fungus infection in your body.
Of course, once it happens, it can evolve your sinuses, eyes, brain and lungs. Once this mucormycosis occurred in the lungs, the chances of survival become very low.
Mostly, it is treated with anti-fungal drugs like Amphotericin B, which is one of the most commonly used drug. However, this drug is also very toxic and may interact and cause harmful effects if not given judiciously.
The preventive measures to curb this infection are mainly avoiding heavy doses of steroids. Similarly, the drugs should be given very cautiously to diabetic patients or patients who have gone under kidney transplants.
Also, it is essential to identify which steroid should be prescribed to a particular patient, and whether to administer it orally or intravenously. The dose is very important as is the duration.
What are the chances of black fungus infection in non-Covid-19 patients?
In non-Covid patients’ chances of fungal infection are very rare because they are not consuming heavy steroids and don’t have any immune depression. But of course, in any patient, who is immune-suppressed whether he is Covid-19 or not chances of getting this type of infection is high.
Studies show that men are more prone to mucormycosis. According to a study done by 4 doctors — 101 cases of Covid-19 patients who have contracted mucormycosis, among 79 men were infected with black fungus. Apart from that 83 people had diabetes mellitus, which is the most important risk factor when it comes to this fungal infection. What’s your take?.
This fungal infection doesn’t have any sex predilection it is equally effective in men and women depending on their status.
In the case of diabetes, sugar levels become erratic and very high, so these patients become more prone to this type of infection because their body resistance and fighting with the infection is very low.
What are the early signs and symptoms of black fungus? What medicine (steroids) Covid-19 patients should avoid if they are doing self-medication?
Early signs and symptoms of black fungus could be a constant headache, facial pain, swelling around the nose and you can see the black crust around the nose and eyes. And later chest pain, difficulty breathing, loss of vision.
Recently, more than 345 children between the age of 10 to 12 years have tested Covid-19 positive in the Dausa district in Rajasthan. Is this an alarming third wave of Covid-19 in India?
This is not the third wave. The third wave is likely to come in the month of November. We don’t know the exact pattern, how the third wave will behave. Children from 6 to 14 years of age have been affected in the second wave also. So this doesn’t depict that we are facing the third wave. The third wave comes after 2 to 3 months of the second wave.
Earlier it was said that a second jab should be taken within 4 weeks of the first dose. But now the medicos are advised to take the second dose in 12-16 weeks. Is it because of the shortage of vaccination? What is the ideal time to take the second jab?
Initially, we didn’t have many studies available about the vaccination results, so it was advised to give the second jab after 4 weeks.
But now, according to the current studies after too many vaccinations have been done, it is found that the people who have taken the second dose of vaccination after 6 to 8 weeks have got better immunity and have better antibody titer. Therefore, it is suggested to take the second jab after 8 weeks even if you can delay it for 3 months.
In India, a lot of people are vaccine-hesitant because of post-vaccination reactions. A report shows 260 doctors died even after being fully vaccinated. Why are so many people dying even after getting fully vaccinated? What is your opinion?
Every vaccination has mild to moderate reactions, depending upon the individual to individual. Vaccination is never harmful, but vaccination doesn’t mean you have 100 percent protection from the disease. So even if you are fully vaccinated, you should take proper precautions.
If you are not taking precautions, not using masks, and getting yourself exposed to Covid-19 patients, you’re likely to get Covid-19. It only gives you protection which means if you get Covid-19 infected, it will not be fatal. It will be of low intensity.
Why is healthy eating important for the immune system, especially during the Covid-19 pandemic? How effective is vaccination on the basis of someone’s immunity?
Healthy eating gives better immunity to the body and can fight the infection in a much better way. If a person has good immunity they can endure any complication in a much better way. Though, vaccination definitely works better if a person has a good immune system.
What are the effects of alcohol and smoking on Covid-19 patients? Are smokers more vulnerable to contracting Covid-19?
Yes, smokers are more vulnerable to the effects of the Covid-19 because their lungs are already damaged and Covid-19 is a lung disease, and this virus badly affected damaged lungs. The chances of mortality will be much higher in the cases of chronic smokers.
Besides, alcohol can have a negative effect on the immune system. It prevents immune cells from working properly. Excessive alcohol consumption can increase the risk of developing Covid-19 induced illness.