Spike in post-dengue, chikungunya mucormycosis cases raises alarm in Pune
Experts attributing the alarming trend to the misuse of high-dose steroids, uncontrolled diabetes, and weakened immunity in patients recovering from dengue and chikungunya
City hospitals are witnessing rare cases of post-dengue, chikungunya mucormycosis, a severe fungal infection commonly known as black fungus, with experts attributing the alarming trend to the misuse of high-dose steroids, uncontrolled diabetes, and weakened immunity in patients recovering from dengue and chikungunya.
In one of the cases, a 38-year-old man from Pune suffering from mucormycosis underwent surgery on November 18. He was suffering from chikungunya and was given steroids to ease the pain by doctor. After 15 days, he complained of teeth pain, swelling in eyes and limited movements of eyes. Later, the infection spread and he developed ophthalmoplegia, a condition that caused paralysis of the eye muscles. He was diagnosed with black fungus infection in sinuses. He underwent surgery and his vision was saved. However, he has been left with lifelong ptosis, or droopy eyelid, said doctors.
Mucormycosis, also known as black fungus, is a rare but serious fungal infection that often manifests in the skin and also affects the sinuses, eyes, lungs and brain. It typically occurs in individuals with compromised immune systems, such as those battling diabetes, cancer, or other illnesses. A similar trend was previously observed amongst the Covid-19 infected patients. However, in a new alarming trend, black fungus infection is been reported among dengue and chikungunya recovered patients.
In another case, a 67-year-old man from Pune post-dengue developed symptoms like watery nose, pain in teeth and swelling of eyes. He visited the Poona Hospital and was diagnosed with black fungal infection in his sinus. The doctors performed maxillectomy surgery during which his upper jawbone was removed. He was discharged last week and will be under observation for the next six months, they said.
According to Dr Murarji Ghadge, ENT consultant at Ruby Hall Clinic, he has come across more than 24 such cases of fungal infection in patients with post-dengue and chikungunya infection since past three to four months. Ghadge said normally he comes across one to two cases of mucormycosis.
“The common findings in these patients was uncontrolled sugar level, unknown diabetic status and use of high doses of steroids. People with underlying health conditions and immunocompromised are vulnerable to develop secondary infection of black fungus,” he said.
Ghadge said that most of the patients coming with the infection are from peripheral areas and were taking treatment for dengue and chikungunya from their physician on an OPD (outpatient department) basis. “There is no treatment protocol for dengue and chikungunya patients. The unjustified overuse of steroids is the reason behind the fungal infection. Not all steroids are bad, but people and doctors should be aware of the sugar level, diabetic condition and underlying health condition of the patient,” he said.
Dr Pushkar Gadre, maxillofacial surgeon at Poona Hospital, said this season he has come across seven patients who underwent surgery due to fungal infection. All were on steroids during their treatment for dengue or chikungunya. “Inappropriate and excessive use of steroids to manage dengue symptoms is a major culprit. Steroids can suppress immunity and spike blood sugar levels, creating an ideal environment for fungal infections to thrive,” he said.
“Patients recovering from dengue or chikungunya are urged to remain vigilant about symptoms such as facial swelling, nasal congestion, black discolouration of skin, or persistent fever, which could indicate a fungal infection. Early diagnosis and timely medical intervention are crucial for survival in mucormycosis,” Dr Gadre said.
The infection was detected relatively frequently among Covid patients. It mainly affects people whose immune system has been breached by another illness, those with health problems or people on immunosuppressants. The treatment for mucormycosis is also costly. The anti-fungal drugs are expensive and are liver and kidney-toxic. People with liver and kidney ailments if diagnosed with black fungal infection need expensive drugs.
According to Dr Aniket Lathi, head, ENT department at Yashwantrao Chavan Memorial Hospital (YCMH)- Postgraduate Institute, earlier one or two cases in a year of black fungus were seen, but lately around three to four cases are reported per month.
“The common thing in such patients is they have diabetes and already fall in the vulnerable category. When they get dengue and chikungunya infections and are given steroids, they later become susceptible to mucormycosis infection present in the environment. Monitoring the sugar level and keeping the diabetes under control is of significance,” he said.