Bhopal: 'Black fungal disease' on the rise at an alarming rate

BHOPAL: Black fungal disease is naso-orbital-cerebral mucormycosis, which is caused due to the unhygienic condition of an immune-compromised Covid patient. This disease is on the rise at an alarming rate in Madhya Pradesh. Each day, nearly 20 cases are coming to the notice of doctors in the state capital for surgery as surgical removal of the infected part is the only way out at a later stage.

This rareóbut seriousódisease occurs mainly in fragile patients, notably diabetics or those undergoing an immunosuppressant treatment.

Stuffy and bleeding nose

Patients suffering from the fungal infection typically have symptoms of stuffy and bleeding nose; swelling of, and pain in, the eyes; drooping of the eyelids; and blurredóand, finally, loss ofóvision. There could be black patches of skin around the nose, ENT Dr SP Dubey said, adding, "Most of the patients arrive late, when theyíre already losing vision, and doctors have to surgically remove the eye to stop the infection from reaching the brain."

Mucorales, normally saprophytic, germinate in the nasal cavities due to an infection and then colonise the sinuses, the orbit, followed by the meninges. Diagnosis must be made before meningeal impairment when faced with a peri-orbital oedema, the beginning of exophtalmy or oculomotor paralysis in high-risk patients with sinusal opacity.

It affects the sinuses, the brain and the lungs and can be life-threatening in diabetic or severely immune-compromised individuals, such as cancer patients or people with HIV/AIDS. Mucormycosis, which has an overall mortality rate of 50%, may be triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients.

In some cases, doctors in India say, patients have lost their vision in both eyes. And, in rare cases, doctors have to surgically remove the jaw bone in order to stop the disease from spreading.

An anti-fungal intravenous injection has to be administered every day for up to eight weeks and this is the only drug effective against the disease.

One way to stall the possibility of the fungal infection is to make sure that Covid-19 patientsóboth during treatment and after recoveryóare being administered the right dose and duration of steroids.

The symptoms

Patients suffering from the fungal infection typically have symptoms of stuffy and bleeding nose; swelling of, and pain in, the eyes; drooping of the eyelids; and blurred and finally, loss of vision.

Steroids reduce inflammation of the lungs for Covid-19 and appear to help stop some of the damage that can happen when the body's immune system goes into an overdrive to fight off coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients. Diabetes lowers the bodyís immune defences, coronavirus exacerbates it, and then steroids which help fight Covid-19 act like fuel to the fire.
Cardiologist Dr Mandal Subroto
The Indian Council of Medical Research (ICMR) has issued guidelines for maintaining hygiene of oxygen masks and water used for oxygen supply. It should be checked at an early stage so ENT should do endoscopy of Covid patients frequently as long as the patients are in hospital. So, the black infection will be detected in the nose and itíll be treated and prevented from spreading to the eyes, and then the brain.
ENT Dr SP Dubey

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