As its second COVID-19 wave continues, India remains embattled by mucormycosis or ‘black fungus’ cases. Black fungus is a fungal infection which has exacerbated the bitter toll of the country’s COVID-19 crisis.
The Indira Gandhi Institute of Medical Sciences (IGIMS) in Bihar state capital Patna is a case in point. The Institute currently houses 101 individuals admitted due to black fungus as of Tuesday, with doctors on guard despite COVID-19 cases stabilising in the state. Of the 101 admitted as a consequence of mucormycosis, 86 recovered from COVID-19 infection.
Nationwide, 28 states and union territories have reported a cumulative total of as many as 28,252 cases of black fungus. Of these cases, 86 percent presented with a history of COVID-19 and 62.3 percent with a history of diabetes according to Union Minister of Health and Family Welfare Dr Harsh Vardhan. Gujarat and Maharashtra account for the most cases of black fungus, at 6,339 and 5,486 respectively.
The link between diabetes and black fungus is of concern, given India’s high burden of the former. As Health Issues India reported last year, “India is a country whose burden of diabetes is rising fast, due to a combination of lifestyle and socioeconomic factors as well as the population’s genetic predisposition towards the disease. In addition, as many as 60.5 percent of Indians fail to properly control their blood sugar – heightening the risk to their health.” We cited a survey from the previous year by the National Diabetes and Diabetic Retinopathy Survey conducted by the All India Institute of Medical Sciences’s Rajendra Prasad Centre for Ophthalmological Sciences, which found that “the overall prevalence of diabetes in the country is 11.8 percent, with men and women almost equally affected. Twelve percent of men are diabetic, compared to 11.7 percent of women.”
The connection between diabetes and black fungus is of note. The first evidence-based mucormycosis study in India showed that black fungus, whilst having come to prominence during the second wave, alarmed doctors during the first as they noted rising numbers of fungal infections. The study spanning sixteen centres across the country found a sharp increase in cases of mucormycosis in 2020, linked to the rise of COVID-19. As Dr Arunaloke Chakrabarti, a professor and head of the Department of Medical Microbiology at the Postgraduate Institute of Medical Education & Research in Chandigarh, explained, quoted by The Indian Express
“The prevalence of COVID Associated Mucormycosis (CAM) was 0.27 percent in patients managed in hospital wards, and 1.6 percent in patients managed in ICUs [intensive care units]. There was a 2.1-fold rise in mucormycosis cases during 2020 in India compared to the year 2019 and the research suggests that this increase is attributable to the COVID-19 pandemic.”
As The Indian Express reports, “it was seen that on an average CAM diagnosis was made eighteen days after COVID-19 infection. The most common sites of infection were found to be the nose with eye (in 58 percent [of] cases) followed by nose with eye and brain involvement (27 percent [of] cases) and then lung infection (nine percent [of] cases). It shows a considerable number of patients reported late to the hospital after the disease progressed to their brain.
“Besides facial pain, nasal blockage and discharge; toothache and loosening of teeth were seen in a high number of cases for the first time. On comparing cases of CAM with mucormycosis without COVID-19 (Non-CAM), it was observed that uncontrolled diabetes mellitus was the most common underlying disease in both groups.”
The findings underscore why we cannot afford to ignore other conditions even as we grapple with COVID-19, given the interplay between various health matters. Black fungus also highlights why we must tackle fungal infections as a whole, particularly those which are drug-resistant.