Gurugram hospitals report 40 black fungus cases

GURUGRAM: A day after the Haryana government classified black fungus (mucormycosis) as a notified disease and directed all districts to share data, it received a list of 70 confirmed cases by Sunday evening. Forty of these patients are admitted in hospitals in Gurugram.
There are more than 200 suspected cases of mucormycosis across the state. Officials said several districts are yet to update their numbers and the health department was expecting more cases in the coming days.
In Gurugram, recovering Covid patients in whom black fungus has manifested are being treated at several leading private hospitals like Max, Fortis, Medanta, Paras and Artemis. These have a history of taking steroids, doctors said. “There are 40 cases of mucormycosis in Gurugram and we have asked all hospitals to share data with us regularly. It will help us understand the magnitude of the problem and we can treat patients at the earliest,” said Dr Virender Yadav, chief medical officer.
According to experts, the infection can be treated with anti-fungals like Amphotericin B. But currently, the drug is not available. “We have informed the state government about the unavailability of the drug. A committee will be constituted to ensure that patients who need the drug get it in time. The state-level panel will approve the requirement after analysing each case,” Yadav added.
Chief minister Manohar Lal Khattar, who was in Gurugram on Sunday, said four medical colleges have been dedicated for the treatment of black fungus. The facilities are PGI Rohtak, Kalpana Chawla Government Medical College, Karnal, SGT Medical College Hospital and Research Institute (Gurugram) and Maharaja Agrasen Medical College in Hisar.
The fungal infection mainly affects Covid patients who are on medication for a long time and have underlying health conditions like diabetes, according to the Indian Council of Medical Research (ICMR). The symptoms include nasal blockage, bloody nasal discharge, reduced sensation in the face, facial periorbital swelling, blurred vision, neurological deficiencies, black lesions in the roof of THE nasal cavity, persistent severe headache, swollen eyes and cheeks and black, dry crusts in the nose.
Dr Amitabh Malik, head of ENT at Paras Hospital, said: “It can be treated by surgically removing all dead and infected tissues. A patient might also need an antifungal therapy for a few weeks. Prolonged use of steroids and use of Tocilizumab are some of the main reasons for people getting affected by the fungus. Using drugs at the correct time and for the right amount of time while treating Covid patients is the only way to prevent it. Since Saturday, we have operated on two people, both in their thirties. They are not diabetic but have mucormycosis. Their blood sugar levels were not monitored properly while administering steroids.”
Although the infection is not new, coupled with Covid, it presents a greater risk. The disease is caused by micro-organisms that are present in the environment. While a person with a good immune system is able fight it, those with Covid are more susceptible because their immunity is compromised.
Dr Rahul Bhargava, principal director, hematology, Fortis Memorial Research Institute, said: “The mortality rate among patients with mucormycosis varies depending on the patient’s underlying conditions and the body part that gets affected. For instance, in rhinocerebral mucormycosis (a rare infection in sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi), the mortality rate varies from 30-70%. If patients develop symptoms, they should get scans and MRI done, along with blood tests. It is of extreme importance to know the duration between RT-PCR reports and development of symptoms associated with black fungus and this should be reported to doctors immediately.”
According to doctors, the most important reason for this sudden spurt in cases has been poor blood sugar management aggravated by the use of steroids during treatment for Covid. Steroids reduce immunity levels and might also increase blood sugar levels. Dr Sameer Kaushal, head of ophthalmology, Artemis Hospitals, said he has seen two patients with mucormycosis in the past two days.
“Usually, it starts from the sinuses (air pockets around the nose and the forehead). The symptoms during this stage may be fever, facial pain, headache, stuffy nose, dental pain, bloody nasal discharge, facial swelling or discolouration. If untreated, and sometimes despite treatment, the infection spreads to the area close to the eyes and the brain. During this stage, symptoms may include swelling of the eye, pain, drooping eyelids, restriction in eye movements, decrease in vision, blackish discolouration of the palate (roof of the mouth) and decrease in level of consciousness.”