With the second wave of COVID-19, hospitals across India are reporting an increase in the number of mucormycosis cases. Mucormycosis is a black fungal infection that occurs in persons with weak immune systems, especially diabetics. It can be fatal if left untreated. However, it is important to note that the infection is not contagious and can be entirely removed if detected at an early stage. So far, the infection has been reported in states such as Gujarat, Maharashtra and Odisha.
In the first wave of the pandemic, doctors had flagged an increase in mucormycosis cases among COVID-19 patients. But during the second wave, an increase in patients with mucormycosis associated with COVID-19 has been reported, said Dr Sonal, Professor and Head of the Department of Maxillofacial Surgery at the Government Dental College and Hospital, Ahmedabad.
“I was treating about 40 patients at a time in the hospital during the first wave. Now, I can see a four-fold increase in patients with Mucormycosis. But this is only expected, as it is proportionate to the surge in COVID-19 cases. We have set up a separate ward specifically for Mucormycosis cases,” Dr Sonal explained.
Though research is yet to establish the links between COVID-19 and the fungal infection, doctors across India have observed that most Mucormycosis cases they treated in 2020 and early 2021 were reported in patients who recently recovered from COVID-19 and had high blood sugar levels.
“We have been seeing non-diabetic COVID-19 recovered patients and those who have had no comorbidities developing the infection. But when we check their blood sugar levels, chances are that it is higher than normal,” Dr Pamod Subhash, an oral and maxillofacial surgeon and office bearer of the Association of Oral and Maxillofacial Surgeons of India, told TNM.
There are many probable factors to increased mucormycosis cases, seen in unsuspecting patients, said Dr Sonal. It has to do with the weakened immune systems and sugar levels, she added.
“COVID-19 itself affects immunity and is found to spike blood sugar levels in patients. We have seen non-diabetics turning temporarily diabetic and we have seen sugar levels of diabetic patients go through the roof,” Dr Sonal said.
Another known factor is exposure to steroids. “We know that steroids increase blood sugar and weaken immune systems. Recently, doctors have also been warned to use distilled water and not tap water during humidification of patients on oxygen support, in order to avoid germs,” Dr Sonal added.
However, even those patients who were not hospitalised or administered steroids have reported mucormycosis, she pointed out.
Unlike the first wave, the fungal infection is being detected at an early stage in the second wave. While cases are high, the number of deaths have been less during the second wave, thanks to early detection, said Dr Sonal.
“Mucormycosis received a lot of media attention and even international news organisations like the BBC carried detailed reports of this infection. As a result, people have become aware and are able to spot the infection early on and consult doctors,” she added.
Mucormycosis is caused by mucormyete molds, an organism present in the air, in leaves, piles of compost, soil and rotting wood. When exposed, the fungus can infect an individual’s central nervous system, eyes, sinuses, lungs, etc. But not everyone exposed to the fungus catches the infection.
Before the pandemic, most mucormycosis cases were being reported in immunocompromised persons, that is, those with uncontrolled diabetes, HIV and cancer. However, the infection is now being detected in healthy people who have recovered from COVID-19.
Early symptoms of the infection include obstruction in the nose, swelling in the eye or cheeks, and black dry crusts in the nose, smelly black nasal discharge, face numbness, fever, cold. If neglected, it can even spread to the eyes and then the brain, making it fatal. If it entered the body via a cut or bruise in the skin, it could show up as blackened skin tissue.
Many of these cases are mucormycosis of the maxilla or upper jaw, which leads to the entire jaw detaching from the skull, in severe cases.
“The infection is so aggressive that it spreads faster than cancer. In 15 days, it can spread from the mouth to the eyes, and within a month, to the brain,” said Dr Pramod.
The most crucial piece of advice is to keep a tab on blood sugar levels, doctors said.
“A typical COVID-19 profile will include blood tests such as CRP (C-Reactive Protein) to check for inflammation level in the body, a complete blood count or CBC test, a D-Dimer test to check for blood clots and ferritin test. Patients must also do an RBS or random blood sugar test to know what their sugar levels are. In case it is higher than normal, the patient can go for medication upon doctor’s advice,” explained Dr Sonal.
It is also imperative to reduce unnecessary and arbitrary administration of steroids to COVID-19 patients, she added.
Read more about the black fungal infection here.