Bombay, India – For 35-year-old Milind Deshmukh, contracting COVID-19 infection has been a devastating life-altering experience.
The mechanical engineer from Thane, a suburb of Bombay, detected a fungal infection known as mucormycosis while fighting viral disease.
Within a month, the rapidly spreading fungus had eaten away at much of the facial tissue, including the right eye and palate.
“He has undergone three surgeries, has lost the sight of one eye permanently and will find it difficult to speak or eat due to the removal of the palate,” Makarand, Deshmukh’s older brother, told Al Jazeera. “Everything is so devastating.”
How many cases have been found?
Doctors in India have been seeing a big boost in cases of aggressive and difficult to treat fungal infection.
Although cases of mucormycosis have been seen in the country previously, the current increase in infections occurs between people infected with COVID-19 and those who have recovered from the disease.
The figures are well above the cases before COVID-19 arrived in India.
“It’s a dangerous situation,” said Dr. Milind Navalakhe, an ear, nose and throat (ENT) surgeon at Bombay Global Hospital who performed palate removal surgery in Deshmukh.
In practice for almost 25 years, Navalakhe would suffer approximately one case of mucormycosis in a week before the pandemic.
“I now see up to 25 cases of mucormycosis in a week, all patients with COVID-19 are already in treatment or recovering,” he said.
The western state of Maharashtra, home of Bombay, has so far recorded about 2,000 cases and eight fatalities due to mucormycosis.
State Health Minister Rajesh Tope has announced the creation of special wards in hospitals to treat fungal disease.
What causes mucormycosis?
Mucormycosis, also known as black fungus or zygomycosis, is caused by a group of mold called mucormycetes.
These fungi live in the environment, especially in the soil and in decaying organic matter, such as leaves, compost piles, or rotten wood, according to the Centers for Disease Control and Prevention.
When someone breathes in these fungal spores, they are likely to have the infection that usually affects the sinuses or lungs.
Medical experts claim that mucormycosis is an “opportunistic infection”: it adheres to people who are fighting disease or taking medications that reduce the body’s ability to fight infections.
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Patients with COVID-19 have weak immunity and many of them take steroids to control a hyperimmune response, making them susceptible to other fungal infections such as mucormycosis, according to experts.
Most mucormycosis infections have been seen in patients with COVID-19 diabetes or in people with elevated and undetected high blood sugar levels.
Poor air quality in India and excess dust in cities like Mumbai facilitate the prosperity of the fungi.
“There is also misuse and overuse of steroids and antibiotics in India which also allows these infections to spread,” Navalakhe said.
Is it spreading?
Doctors in India’s capital, New Delhi, have also begun witnessing an outbreak in cases of mucormycosis.
The city, home to nearly 20 million people, is under a bloody second wave of COVID-19, and doctors predict a larger outbreak of fungal infections.
“We are seeing a three to three times higher number of cases of mucormycosis,” said Dr. Neha Gupta, a specialist in internal medicine and infectious diseases at Medanta Hospital in Gurugram, a suburb of the Indian capital.
He said patients come in with symptoms such as falling loose teeth or falls, severe facial pain and facial swelling.
“Before we would see rare cases of mucormycosis among people who have suffered traffic accidents or severe diabetes. But now all cases are related to COVID-19, ”he said.
Mucormycosis is also known to occur on the skin if the fungus enters through a cut, brush, or other lesions. Patients who have had organ transplants are also known to be susceptible.
In the western state of Gujarat, hospitals have begun preparing rooms amid growing cases of fungal infection.
State officials have also placed orders for the antifungal drug called amphotericin-B, which is crucial in the treatment of mucormycosis.
Although the Gujarat government has been notified of nearly 100 cases, doctors say the actual figures could be much higher.
Dr. Dinesh Harani, an ENT surgeon in Gandhidham, Kutch district of Gujarat, told Al Jazeera that he has referred five patients with mucormycosis for surgeries in Ahmedabad, the largest city in the state, in the past three days. .
“I haven’t seen any cases of mucormycosis in my 35 years of practice so far,” said Harani, who runs a small four-bed medical center.
“Amphotericin-B injection is also scarce,” he said.
Ahmedabad Civil Hospital has admitted 19 patients with mucormycosis over the past week. Many government and private hospitals in other cities in the state, including Surat, Anand and Vadodara, have also reported cases.
Treatment for mucormycosis is expensive. Surgical removal of infected tissue is the main treatment for infection, in addition to a long course of antifungal medication.
“Mucormycosis is like a rapidly expanding cancer that invades the body,” he told Al Jazeera, a Bombay-based infectious disease specialist.
“The overall costs of treatment, including surgeries, amount to 40,000,000 Indian rupees ($ 54,452) to 50,000,000 Indian rupees ($ 68,065).”