Spores of pathogenic fungi are abundant in soil, manure, rotten fruit, and even on the mucous membranes of healthy people. On Saturday morning, Mumbai eye surgeon Dr. Akshay Nair prepared to operate on a 25-year-old woman who had recovered from the coronavirus only three weeks earlier. Meanwhile, the otolaryngologist was working with a diabetic patient, removing tissue from the nasal cavity affected by an aggressive fungal infection that affects the nasal mucosa, eyes, and sometimes even the brain. After his colleague finished, Dr. Nair had to perform a three-hour surgery to remove the eye. “I will have to remove the eye to save the patient’s life, because that is the course of this disease,” the doctor told me before the operation.
Not only is the second wave of Covid-19 raging in India, but now doctors are reporting a sharp increase in cases of a rare infection called “black fungus” among those who have recovered from or are still suffering from the coronavirus.
Mucormycosis in humans (animals are also susceptible) is a highly aggressive disease caused by various species of fungi in the Mucoraceae family. These fungi feed on organic matter and are widespread: they can be found in soil, plants, decaying fruits and vegetables, and animal manure. Normally, a fungus is not dangerous, but for people with weakened immune systems, such as those with diabetes, cancer, or HIV/AIDS, it can pose a deadly threat by attacking the lining of the nose, lungs, and even the brain.
“This fungus can be found in the soil, in the air, and even in the nasal mucosa of healthy people,” says Dr. Nair. Dr. Nair believes that steroids, which are actively and successfully used in cases of severe Covid-19, can trigger the development of mucormycosis in patients with or who have recovered from coronavirus (which can be fatal in 50% of cases). Steroids reduce lung inflammation and prevent the immune system from causing additional damage to the body by overreacting to the coronavirus. At the same time, however, steroids lower immunity and raise blood sugar levels. Such a weakening of the immune system can lead to the development of mucormycosis.
For many patients with coronavirus, steroids are the only hope. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of episodes should remain the same. End of story. Podcast advertising. “Diabetes reduces the body’s ability to protect itself, the coronavirus exacerbates this effect, and then steroids, which help fight Covid-19, add fuel to the fire,” says Dr. Nair. He works in Mumbai, one of the cities hardest hit by the second wave of the coronavirus, and in April he saw about 40 patients with fungal infections. Many of these people were diabetics who had contracted the coronavirus at home. Eleven of them were hospitalized and had their eyes removed. Between December and February, six of Dr. Naira’s colleagues in Mumbai, Bangalore, Hyderabad, and Pune reported 58 cases of mucormycosis, with the majority of patients becoming infected 12-15 days after recovery from COVID-19. According to Dr. Renuka Bradu, head of otolaryngology at one of Mumbai’s leading hospitals, Sion, 24 cases of fungal infection have been recorded in the past two months, compared to six cases in the entire previous year. At the same time, 11 infected people had to have an eye removed, and six died. The majority of Dr. Bradu’s patients were middle-aged individuals with diabetes, and the fungal infection struck them a few weeks after they had recovered from the coronavirus. “Now we have two to three cases of mucormycosis infection every week. It’s a nightmare in the context of the pandemic,” Renuka Bradu told me.
Doctors are surprised by the frequency and severity of this fungal infection during the second wave of the pandemic in India. Dr. Raghu Raj Hegde from Bangalore in southern India tells a similar story. In the past two weeks, he has seen 19 cases of mucormycosis, mostly in young patients. According to him, “Some of them were in such bad shape that we couldn’t even operate on them. Doctors admit to being surprised by the frequency and severity of fungal disease in the second wave compared to the first wave of the pandemic last year. Dr. Nair says he has seen no more than a dozen cases of such infection in Mumbai in the past two years, but this year is different. And Dr. Hegde in Bangalore, in his 10 years of practice, would encounter such a situation no more than once or twice a year.
Mumbai was hit harder by the second wave of the pandemic than many other cities in India. Typically, patients with mucormycosis experience nasal congestion or bleeding, swelling and pain in the eyes, drooping eyelids, deterioration and eventual loss of vision. There may also be a darkening of the skin around the nose. Doctors say patients with mucormycosis often present at a late stage of the disease when they have already lost their vision, so surgeons usually have to remove one eye to prevent the infection from reaching the brain. In some cases, according to Indian specialists, people can go completely blind. In rare cases, it is necessary to remove the jaw to stop the spread of the infection. Only one drug is effective against the disease – an antifungal intravenous injection that costs $48 per dose and should be administered daily for eight weeks. According to diabetologist Dr. Rahul Baxi of Mumbai, it is possible to prevent fungal infections by following the correct steroid dosage during and after COVID-19 treatment. He claims that out of 800 diabetic patients who went through his regimen and were infected with coronavirus, none developed mucormycosis. “Physicians should closely monitor the blood glucose levels of discharged patients,” advises Dr. Baxi. Indian authorities claim there is no major outbreak of mucormycosis, but reports of new infected cases continue to come in from all corners of the country. “This strain of the virus is very virulent, which significantly increases blood sugar levels in patients,” says Dr. Hegde. “And surprisingly, the fungal infection affects many young people.” Last month, a 27-year-old man who didn’t even have diabetes became his youngest patient. “We had to operate on him when he was sick with the coronavirus for the second week and remove the eye. Of course, it was a real catastrophe for him,” says the doctor.