A rare fungal disease, Mucormycosis, most commonly affects the sinuses or the lungs, with some afflicted by the malady losing their eyesight, nose, and jaw bone. Nose obstruction, swelling in the eyes or cheeks, and black dry crusts in the nose are among the early symptoms of the infection.
With a mortality rate of 50 percent, doctors believe it may be triggered by the use of steroids. Also known as black fungus, it has been detected as a post-COVID-19 complication, including among those who have uncontrolled diabetes.
Dr Aditi Dusaj, a senior ophthalmologist from the Sri Balaji Action Medical Institute, has explained why Mucormycosis is more prevalent among Indians.
Sputnik: Could you explain what Mucormycosis is? How dangerous is it?
Dr Dusaj: Mucormycosis is a deadly fungal infection, it's rare but life-threatening. The fungus belongs to the Zygomycota group. Fatality in this infection is around 50-60 percent. If the fungus is limited to the sinuses, the fatality rate is 40-45 percent, but if it invades the lung area, which is also known as pulmonary Mucormycosis, the fatality rate is 70-80 percent. If it spreads to the brain, sinuses, and lungs, the fatality rate is almost 90-100 percent. One has to be very careful, and treatment has to start at an early stage.
Sputnik: Many cases of Mucormycosis are being reported during the second wave of COVID-19 in India. What are the reasons for this outbreak?
Dr Dusaj: During the first wave, the lockdown was introduced at a very early stage. At that time, we reported fewer cases, hence complications related to COVID-19 were low. Nevertheless, a few cases of Mucormycosis were reported last year too, but they were really low. As the number of COVID-19 cases surged this time, more cases of complications related to COVID-19 occurred.
Sputnik: India is not the only country to have reported a dramatic spike in COVID-19 cases, but we haven't heard of a Mucormycosis outbreak in other countries. Why?
Dr Dusaj: India or New Delhi is also known as the diabetic capital of the world: more diabetes cases, more Mucormycosis cases. I agree that India is the only country seeing a huge spike in these cases in the COVID-19 pandemic. What's driving this deadly infection is uncertain, but it may be related to patient factors (diabetes, steroid use) and also the virulence of the virus (suppression of a patient's immunity and low lymphocyte count).
Sputnik: Who should take more precautions?
Dr Dusaj: Patients who have a history of uncontrolled sugar, diabetes, or using steroids, using immunosuppressive drugs should be more cautious. Additionally, any patient with a high iron level in the blood should be cautious, because the fungus binds up with the iron.
Those who have low immunity are also susceptible to black fungus.
Sputnik: There have been multiple reports about Mucormycosis patients losing their eyesight.
Dr Dusaj: The fungal infection starts in the nose, spreading to the paranasal areas, eyes, lungs, and the brain. From the eyes, it can spread directly to the brain. Hence, to stop the fungus from spreading to the brain, eyes need to be removed.
This is a life-saving surgery. The whole idea of removing eyes for any patient could be scary. But life is important, and sadly, using medication only cannot stop the spread of the fungal infection.
Sputnik: What are the preliminary signs?
Dr Dusaj: The patient and doctor need to look for a black spot on the eye and nose area or infra orbital area post-COVID-19 infection. One needs to be very vigilant and get an opinion from an eye specialist.
Black fungus is an angioinvasive fungus that affects the arteries and blood vessel walls, resulting in catastrophic tissue ischemia, infarct, and necrosis. And this necrosis looks like a black spot, which if not treated, eats away the nose, paranasal area, and then keeps spreading in the brain. The focus should also be on the prevention of Mucormycosis. Preventive strategies should be incorporated along with the treatment of COVID-19. Good diabetes care and pre-diabetes care are critical to avoid contracting the infection.