- An epidemic of ‘black fungus’ cases has surged in India in the wake of a spike in COVID-19.
- Symptoms of black fungus (mucormycosis) include facial swelling, nasal congestion, and headache.
- If the lungs are infected, symptoms include fever, cough, and shortness of breath.
A surge in cases of mucormycosis, also known as black fungus, is affecting India — a country already experiencing a severe rise in COVID-19 cases.
More than 9,000 cases of the fungus have been reported, according to the Associated Press. And medication to treat it is running low.
This potentially fatal fungal infection is likely increasing due to the surge of people with COVID-19. Fighting the coronavirus can leave people’s immune systems compromised or weakened, which means they may have a higher chance of developing mucormycosis.
Healthline spoke with experts to better understand what might have caused India’s worsening health emergency.
A rare disease
According to the Centers for Disease Control and Prevention (CDC), mucormycosis is caused by a group of molds called mucormycetes, which are found in soil and organic matter, like compost piles.
The infection typically affects people with health problems (like COVID-19) or those who take medicines that can lower the immune system’s ability to fight infection.
It commonly affects the sinuses or lungs after the fungal spores are inhaled from the air.
“Mucormycosis is a fungal infection that tends to infect people who have suppressed immune systems, such as people with severe diabetes,” Dr. Eric Cioe-Peña, director of global health at Northwell Health in New York, told Healthline. “Once it infects you, it’s very morbid and has a high mortality.”
Symptoms of sinus and brain mucormycosis include facial swelling, nasal congestion, and headache. If it makes it to the lungs, symptoms include fever, cough, and shortness of breath.
Depending on what part of the body is affected, mucormycosis can be fatal in up to 96 percent of cases.
Combination of factors might have caused epidemic
Dr. Kishorbhai Gangani, internist at Texas Health Arlington Memorial Hospital explained that India was relatively lucky during the country’s first wave of COVID-19, but that a combination of factors set the stage for the current surge in COVID-19 and mucormycosis cases.
According to Gangani, elections and associated mass rallies were happening, and it was a time of year when many weddings happen — and crucially, there were no COVID-19 restrictions.
“Government probably focused more on elections than on anything else,” he said. “At that time it was happening all over India, and the focus was shifted. It was bad timing.”
Gangani explained that a typical Indian wedding can involve up to 1,000 people, and that the country’s infrastructure was never ready for a surge of this magnitude.
“And the strain they have is very virulent, and they didn’t expect that this was going to be a fast transmitting strain and more virulent which will make more people sicker, faster,” he added.
With so many people experiencing compromised immunity from COVID-19, a surge in mucormycosis became more likely.
Misinformation caused fear of vaccine
Gangani said the COVID-19 surge began at the start of the vaccine campaign, causing many to believe the vaccine was causing, rather than treating, the disease.
“The second wave started and people, some people, actually started thinking that they’re getting infected because they got the vaccine,” he said. “And then the rumors started spreading.”
Gangani even had a hard time convincing his own family of the truth. He said that he tried to correct this misinformation when speaking with his relatives there, but they didn’t believe him.
Use of steroid drugs to treat COVID-19 set stage for mucormycosis
“Statistical analysis has proven that steroid drugs are useful in reducing mortality (death rate) in COVID patients with low oxygen saturation levels,” said Dr. Donna Casey, internist at Texas Health Presbyterian Hospital in Dallas. “Steroids reduce inflammation; however, they can negatively affect your ability to fight infection.”
Gangani explained that if people aren’t given the appropriate dosage of steroid drugs, they can have a higher chance for contracting another infection.
“An important thing is using it wisely and timely — and that’s where the trouble comes in, knowing when to use [steroid drugs] and how much to give,” he said.
Additionally, people with other chronic conditions such as diabetes can be at higher risk for mucormycosis.
“If they [COVID patients] have uncontrolled blood sugars to begin with, and if you use steroid on top of that, their blood sugar is going to be very uncontrolled,” he said. “High blood sugar will lead to acidic blood, and this particular fungus, it actually thrives in high blood sugar and high acidic environments.”
Dr. Minh Nghi, an internist at Texas Health Harris Methodist Hospital Southwest in Fort Worth, Texas pointed out that people living with diabetes and COVID-19 are at a disadvantage, “as they have both diabetes and also are likely to be given steroids as a treatment for COVID.”
“Anyone with a suppressed immune system is at risk for mucormycosis,” said Nghi. “This is an opportunistic fungal infection that is commonly seen in diabetes, steroid use, solid organ transplant patients, and anyone with a suppressed immune system.”
Oxygen shortage might be associated with mucormycosis epidemic
According to Gangani, a shortage of oxygen tanks and delivery devices might have created another vector for mucormycosis contamination.
“The biggest thing I have in my mind, why they are seeing so many mucormycosis cases is that in India there was severe shortage of oxygen,” he said. “So they had to pull in from wherever they get either oxygen tanks or cylinders and some of them were outdated and who knows [if] those appliances or oxygen delivery systems were colonized [by the fungus].”
The bottom line
An epidemic of black fungus is sweeping India in the wake of a severe surge in COVID-19 cases.
Experts said the cause is a combination of factors. These factors might include contaminated oxygen equipment and use of steroid drugs to treat certain COVID-19 patients.
Experts also said that poor preparation for a second wave of COVID-19, misinformation about vaccine effectiveness, and relaxed COVID-19 restrictions during a time of year filled with mass gatherings heavily contributed to the current health emergency.
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