A black fungus with a mortality rate of 50 per cent is increasingly infecting recovered Covid-19 patients in India, with doctors forced to remove parts of the face of some sufferers to save lives.
Mucormycosis, caused by a mucor mould commonly found in soils and decaying vegetables, infects the sinuses, the brain, and the lungs of immuno-compromised people.
Prior to the coronavirus pandemic, mucormycosis was extremely rare, with just a few cases annually. But, leading hospitals across India are now seeing multiple cases daily.
If it is feared that the mucor will spread to the brain then invasive surgery is a last-ditch recourse, with Indian doctors being forced to remove the infected jaw bone, nose, and eyes of patients.
“The situation here has improved in terms of numbers of Covid-19 patients requiring admission but mucormycosis is now playing absolute havoc,” said Dr Prashant Rahate, the Chairman of SevenStar Hospital in the city of Nagpur, which has treated more black fungus patients than any other facility in central India.
The black fungus has a mortality rate of 50 per cent, according to the US Centers for Disease Control and Prevention, although the survival rate increases significantly with early diagnosis and treatment, according to Dr Rahate.
“We are seeing four to five new patients every day and have around 35 patients still admitted,” Dr Rahate added.
Currently, the only available medicine is intravenous antifungal infections but many Indians cannot afford the ₹3,500 (£33) daily cost.
In Gujarat, one of the Indian states hit hard by the second wave, every government-run hospital will now have a specialist mucormycosis ward.
On Saturday, the BJ Medical College Hospital in the city of Ahmedabad said there were at least 45 patients waiting to undergo surgery, while in the city of Surat, at least 40 cases of mucormycosis have been detected in two weeks.
Part of the reason for the flare-up is thought to be the increased use of steroids to treat mild cases of Covid-19, which compromise the body’s immune response to infections such as mucormycosis.
India’s devastating Covid-19 second wave has seen the country record more than 300,000 daily infections for 20 days and is predicted to surpass one million deaths by August.
Mucormycosis, colloquially known as the “black fungus”, is a fast-moving infection that attacks a person’s sinuses, lungs and brain. While there are antifungal treatments that can be used to treat the condition, poor diagnosis means it is often detected only after the fungus has spread rapidly.
“The fungus grows incredibly fast,” says David Denning, a professor of infectious diseases at the University of Manchester and chief executive of the Global Action Fund for Fungal Infections (Gaffi). “Once it gets in, it just marches through the tissue and doesn’t respect tissue planes, so it can go straight from ordinary tissue through into bone, into nerves.”
He adds that the mortality rate is, typically, around 50 per cent – but it can be as high as 80 per cent if diagnosed late.
Experts estimate that in Britain or France, there are between two and 10 cases per million people, per year. In India the baseline level is much higher, more like 17 per million.
“That’s probably a function of high incidence of poorly controlled diabetes,” says Prof Denning. “It’s also a dusty environment, there’s a lot of material in the air. So I think you’ve got a triple effect: essentially there’s lots of exposure, so a population that gets this disease a bit more often; poorly controlled or out of control diabetes; and then add steroids to treat severe Covid-19 into the mix.”