Uncontrolled diabetes, improper steroid use key in emergence of black fungus: PGIMER study
Many, who have survived the Covid-19 virus, are now battling a fungal infection, mucormycosis, commonly called black fungus, which is “deadlier” than the virus itself.
A study conducted by the Post Graduate Institute of Medical Education and Research (PGIMER) shows how uncontrolled diabetes and improper steroid use are important factors for the emergence of this infection. In Chandigarh hospitals alone, over 200 patients have died of the fungal infection.
The study, MucoCovi (Muco from mucormycosis, Covi from Covid-19), was led by PGIMER along with 16 other centres. The institutes studied black fungus cases reported from September 1 to December 31, 2020, and the results were published in the Emerging Infectious Disease Journal, USA, on June 4.
The researchers found that the prevalence of Covid associated mucormycosis (CAM) was more among patients managed in the ICUs (1.6%) than in the wards (.27%). Also, because of the pandemic, there was a 2.1-fold rise in cases during 2020, when compared to the previous year.
The head of the department of medical microbiology, PGIMER, Dr Arunaloke Chakrabarti, shared that the clinicians should be vigilant for black fungus in patients recovering from Covid, especially those with new or previously diagnosed diabetes mellitus, and those reporting clinical manifestations of facial or orbital pain or black or blood-stained nasal discharge or loosening of teeth.
“It was seen that on an average CAM diagnosis was made 18 days after Covid-19 infection. The most common sites of infection were found to be the nose with eye involvement (in 58% cases) followed by nose with eye and brain involvement (27% cases) and then lung infection (9% cases),” he said.
Besides facial pain, nasal blockage and discharge, toothache and loosening of teeth were seen in a high number of cases for the first time.
The doctor said that uncontrolled diabetes mellitus was the most common underlying disease. “This study has suggested that there is a direct role of Covid in causing or worsening diabetes, which may predispose these patients to mucormycosis.”
Covid patients with diabetes developed CAM as early as less than eight days of getting Covid. On the other hand, those patients who developed CAM later had mostly received inappropriate steroid treatment (63%).
The overall death rate due to mucormycosis was 38.3% at six weeks and 45.7% after 12 weeks of illness. “Patients over 54 years of age, those with brain or lung involvement and those who had to undergo ICU admission had a higher risk for death,” he said. He claimed this study to be the first evidence-based multicentre study on mucormycosis from India.