Rajat Sharma

A new deadly challenge called Black Fungus

AKBThe new deadly Black Fungus disease, known as Mucormycosis, is spreading fast in several states of India as the number of cases now runs into several thousands. Reports of Black Fungus disease have started coming from several cities and states.
More than 1,500 cases from Maharashtra and more than a thousand cases from Gujarat have been reported. The disease is spreading fast in Madhya Pradesh, Uttar Pradesh, Haryana, Rajasthan, Bihar, Uttarakhand, Punjab and Delhi. The Centre is yet to tabulate statistics about black fungus from all states.
Rajasthan and Telangana governments have declared Black Fungus as a notified disease under Epidemic Act. Black Fungus cases are seen among patients who were infected with Covid and were given steroids during treatment. This disease is striking those who are patients of diabetes and cancer.
On Wednesday night, AIIMS Rajendra Prasad Centre for Opthalmic Studies released guidelines for early detection and prevention of this disease in the AIIMS Covid Ward. Patients and their caretakers must be on the lookout for particular signs to help early detection.
According to the AIIMS guidelines: Physicians treating “high risk” Covid patients have been asked to identify (1) Patients with uncontrolled diabetes, diabetic ketoacidosis, and diabetics on steroids or tocilizumab, (2) Patients on immune-suppressants or anti-cancer treatment, and patients with chronic debilitating illness (3) patients on high dose steroids and or long duration of steroids or tocilizumab (4) severe Covid cases and (5) Patients on oxygen support – nasal sprongs, by mask, or on ventilator.

Patients and their caretakers must be on the look out for these danger signs: (1) abnormal black discharge or crust, or bleeding from the nose (2) nasal blockage (3) headache or eye pain (4) swelling around the eyes, double vision, redness of eye loss of vision, difficulty in closing eye, inability to open the eye, prominence of eye (5) facial numbness or tingling sensation, difficulty in chewing or opening the mouth.

Patients have also been advised to conduct regular elf-examinations. These include (1) a full face examination in daylight for facial swelling – especially of the nose, cheeks, around the eyes – or black discoloration, hardening, and pain on touch; as well as (2) oral and nasal examinations using a torch to check for blackening and swelling inside the mouth or nose. If a patient detects any of these signs, he or she must consult an ophthalmologist or ENT specialist immediately and not self-medicate with steroids, antibiotic or anti-fungal drugs.

Mucormycosis is spreading fast in Delhi too. Till Wednesday, there were 80 to 100 patients admitted in AIIMS, nearly 50 in Sir Gangaram hospital (with 16 others waiting for admission), 25 in Max hospital, 12 in Lady Hardinge hospital, five in RML Hospital, 10 in Apollo hospital and nearly 20 patients in Akash Hospital. Doctors say, this disease is fatal, and can cause severe disfiguration of the face after surgery. The patients may lose their vision. Separate wards for mucormycosis have been set up in all medical college hospitals of Haryana.

Black fungus patients are mainly those who had fully recovered from Covid-19 and had returned home, but due to fungal infection they soon had a blurry vision, had fever, cough and bleeding from nose. One black fungus patient has died in Delhi’s Moolchand Hospital. According to Dr Padma Shrivastav, Head of Neurology in AIIMS, separate black fungus wards have been created at AIIMS Trauma Centre and at AIIMS Jhajjar. She said, almost 20 black fungus cases are being reported daily in AIIMS. She said, the most worrying part now is that the black fungus has started targeting young people, who had no diabetic history, never came into contact with any wet surface, never took oxygen, and were in home isolation.

Maharashtra now leads the list of black fungus cases in India. Till now, more than 1,500 black fungus cases have been reported across Maharashtra, according to the state health minister. Nearly 500 of them have recovered, and another 850 patients are presently undergoing treatment. Ninety black fungus patients have died till now. The state health minister said, there is severe shortage of Amphotericin-B injections, used for treating black fungus patients. Earlier, when the disease was not rampant, there was hardly any demand, but now, the state needs 6,000 vials on daily basis. Maharashtra government has ordered 1.9 lakh vials while Delhi government has placed order for one lakh vials of this key medicine.

Rajasthan, which has declared black fungus as an epidemic, has reported more than 750 patients till Wednesday. Out of these, more than 100 patients are in Jaipur alone, while there are 50 patients in Jodhpur. A special OPD has been set up at Sawai Man Singh hospital in Jaipur. All black fungus patients have been included in Chiranjeevi scheme, under which they will get medical cover up to Rs 5 lakh. The state government has sought 50,000 vials of Amphotericin-B from the Centre, due to severe shortage.

Only nine pharma companies in India produce Liposomal amphotericin-B injections. The doses are decided based on the weight of the patient. On average, a patient may require 60 to 80 vials, or even more of this drug. Since the number of patients are now in thousands, there is acute shortage of this drug. Pharma companies like Cipla, Sun Pharma, Bharat Serum, Ranbaxy, Lifecare, Intas, and Critical Care may take 10 to 15 days to ramp up production of this injection, because the salt needed for production needs to be imported.

In Gujarat, more than 1,100 black fungus cases have been reported from Ahmedabad, Surat, Rajkot and Vadodara. Many of the patients have lost their vision. Doctors say, one patient needs 120 vials for a full treatment. Though the state government has sent 5,000 vials to each city, it appears to be inadequate. In Madhya Pradesh, 421 black fungus patients have been detected till Tuesday, but the number jumped to 570 by Wednesday. Most of the cases have been reported from Bhopal, Indore and Gwalior.

To sum up: We need not fear, but fight the Black Fungus. Everybody needs to be careful. According to doctors, steroids given to critical Covid patients during treatment cause hike in sugar level, and if one is a diabetic, the risks of catching the fungus are heavy. I have already given the guidelines and precautions prepared by AIIMS in the beginning of this blog. One should go through them carefully, and be on guard. If you notice those symptoms, get in touch with a doctor immediately. Doctors are still perplexed about whether it could be another variant of the Coronavirus.

I spoke to Indian Medical Association officials, who said that Indian pharma companies were manufacturing this drug by importing salts till last year, but the DCGI (Drugs Controller General of India) later withdrew the permission. IMA officials said, the Centre should give permission for emergency short term production of this drug. Indian pharma companies need to boost production of this key drug on an immediate basis so that we can win the battle against mycormucosis.

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