Doctors blame irrational steroid, zinc use for rising black fungus cases

PATNA: Even as the state government has notified mucormycosis, commonly known as black fungus, as an epidemic, experts observed that this rare disease affects the Covid patients either during their treatment or after recovery. The disease is caused by a mould found in soil and in decaying organic matter and affects mostly immune-compromised individuals, ones with poorly-controlled diabetes or those administered high doses of steroids, they said.
Joint director of Indira Gandhi Institute of Cardiology (IGIC) A K Ashu said healthcare providers are inadvertently seeding mucorales, the virus which causes black fungus, in Covid patients. “Prolonged use of masks covering nose and mouth contributing to humidity and smoldering pathogens inside may cause this infection in people. Poorly and hardly ever replaced nasal catheters/prongs with adhesive plasters applied, oxygen humidifier and other hospital equipment and accessories also result in such infections,” he said.
Dr Ashu prolonged and unwarranted use of high doses of steroids, blunderbuss of broad spectrum antibiotics and other immuno-modulators to curb cytokine storms or even without, are the reasons for opportunistic infections like mucormycosis. “The usual antifungal drugs like Voriconazole used in intensive care are effective against candidosis or aspergillosis, but not at all against mucormycosis (black fungus). Only polyenes are effective in treating black fungus,” he added.
Paediatrician and viral disease expert Dr Arun Shah said black fungus affects the sinuses, eyes, brain and the lungs and can be life-threatening in diabetic or severely immune-compromised individuals, such as cancer patients or people with dialysis and chemotherapy. “It is usually triggered by the use of steroids, a standard care and a life-saving treatment for severe and critically ill Covid-19 patients. Though the steroids reduce inflammation in the lungs, they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid patients. This drop in immunity along with high blood sugar due to steroids could be triggering these cases of black fungus,” he said.
Dr Shah said one way to prevent the possibility of this deadly fungal infection is to ensure that during Covid treatment, steroids are being administered judiciously in the right dose and duration as per the guidelines. Steroids are not recommended in mild disease, but in moderate to severe cases only.
Gynaecologist Dr Punam Raman said people are using steroids in rheumatoid arthritis, vascular collagen disorder, interstitial pneumonia, some varieties of glomerulonephritis and several allergic conditions of skin for years, but this black fungus (actually this fungus is not exactly black in colour but named so due to tissue necrosis caused by fungus) was hardly seen. This infection in Covid cases may be caused by several factors, but one of the important factors cited by medical researchers recently is the excessive use of zinc.