Delhi reports 185 cases of black fungus, in possible fallout of Covid-19 surge
Despite a decline in the number of Covid-19 cases, hospitals have started reporting an increase in cases of mucormycosis, or black fungus, resulting in a shortage of antifungal medicines used to treat the infection.
Hospitals said at least 185 patients have contracted the fungal infection after being infected with Covid-19, and are admitted to seven Delhi hospitals. Smaller facilities are referring their patients to larger public and private hospitals such as the All India Institute of Medical Sciences (AIIMS), which was treating 61 patients with the infection as on Wednesday, and Sir Ganga Ram hospital, which was treating 69.
AIIMS, which gets patients from across the country, used to otherwise see only 12 to 15 cases of the rare infection in a year.
Black fungus has been found mostly among people with uncontrolled diabetes, whose immunity is compromised, or among people who are given excessive steroids or immunity-modulating drugs such as tocilizumab. According to doctors, if left untreated, it could kill up to 80% of those infected. If not detected early, it affects the orbit of the eye and the mouth, resulting in people losing their vision or jaw during debridement — the process of removing dead tissue from an infection or wound.
Doctors at Sir Ganga Ram hospital said they saw a small surge in cases last December as well, after the November surge in Covid-19 cases in the city. In December, Ganga Ram reported 10 cases in two weeks.
“We have seen almost 100 cases of the infection from May 7 or 8. Several smaller hospitals across the city are also referring patients to us,” said Dr Ajay Swaroop, head of the ENT department at Sir Ganga Ram hospital.
There were 25 patients with the infection admitted across Max hospitals in Delhi, 15 at Indraprastha Apollo, 10 at Manipal Hospital, and at least three at Fortis (Vasant Kunj). The Delhi government-run Lok Nayak hospital got its first case of black fungus on Wednesday.
“We currently have two patients confirmed to have the infection and two others suspected to have the infection, undergoing tests. The cases have been referred to us from small nursing homes. There has been an increase in mucormycosis cases mainly due to the overuse of steroids,” said a senior doctor at Lok Nayak hospital.
“We are seeing a high number of mucormycosis, probably because of two reasons. One, this wave of Covid-19 was massive in comparison to last year; and two, the treatment protocol has evolved since last year. While the evidence shows that steroids make a difference in Covid-19 patients, they were used beyond the recommended guidelines,” said Dr Alok Thakar, head of the ENT department at AIIMS.
Doctors said they have also seen cases of mucormycosis among Covid-19 patients who took steroids at home without adequate medical consultation.
Dr Sumit Mrig, head of the ENT department at Max hospital, Saket, said, “People have been taking steroids at home without supervision; many of them were pre-diabetic and not aware of their sugar levels, thus causing mucormycosis.”
The sudden increase in black fungus cases has led to a sharp rise in demand for the drug Amphotericin B. “It is the only drug to treat mucormycosis,” said Dr Swaroop.
To prevent black-marketing and overuse, the Delhi government has set up a four-member committee that will meet twice a day to review hospitals’ applications for the use of the medicine.
Health minister Satyendar Jain on Wednesday said, “The treatment of the infection can be done only in hospitals, so the drug is directly being given to hospitals. Production is not too much, but we’ve asked for extra doses -- we have asked for one lakh doses of the medicine.”