Black Fungus’ Scare is Real but Not New to SL
BY Faadhila Thassim
The detection of ‘black fungus’ in COVID-19 patients has been a growing concern with the increase in the number of cases and deaths reported in India.
In this backdrop, ‘black fungus’ detection in COVID-19 patients in Sri Lanka was put under the spotlight with the information on the death of an individual who is believed to have been infected with ‘black fungus'.
What is black fungus?
Mucormycosis, often termed as ‘black fungus’, is a rare yet serious fungal infection.
Prof. Suranjith Seneviratne, Professor and Consultant in Clinical Immunology and Allergy at the Royal Free Hospital and University College London said that it is commonly found in soil, rotting food and other organic matter and damp areas around construction sites.
He added that the most common methods of contraction is through inhalation, swallowing and by wound contamination on skin.
Has ‘black fungus’ developed in COVID-19 patients in Sri Lanka?
The fear of the spread of black fungus amongst COVID-19 patients in Sri Lanka transpired when an individual who was tested positive for COVID-19 died due to a fungal infection which was believed to have been the ‘black fungus'.
The District General Hospital Ampara refuting such claims said that the patient had been admitted to the Hospital with a disease caused by a type of yeast and that the said the patient was prone to get the fungal infection, as he was on immunosuppressant medication.
Meanwhile Head of the Fungal Department of the Medical Research Institute Dr. Primali Jayasekara clearing all misconceptions, stated that there has not been any COVID-19-associated Mucormycosis cases reported in Sri Lanka to date.
Is there any possibility of a sudden outbreak of COVID-19 - associated Mucormycosis cases in SL & are we prepared to face such an eventuality?
Dr. Jayasekara said that although the term ‘black fungus' became a widely discussed topic in the recent past, this is a fungal infection that has been in our country since 2019.
She added that there have been over 42 cases reported in 2019, 24 cases in 2020 and 24 cases in 2021 to date.
“Sri Lanka is a country which has the necessary environment for the growth of this fungus and it could also be found in our soil” she said adding that this infection is not transmissible and could not thereby spread from one individual to another once infected.
When questioned about the possible future detection of cases in relation to COVID-19-associated Mucormycosis, she added that as this is a condition that has been existing in the country, every doctor in the country and specialist doctors are aware of the necessary treatment adding that there are sufficient facilities in Sri Lanka to treat such patients and that thereby there is no need for unnecessary fear among the public.
How does ‘black fungus’ develop?
Prof. Seneviratne said that it grows well in body temperature and acidic environment such as dead or dying tissue and uncontrolled diabetes.
He added that if one has immune deficiency, a weak immune system or uncontrolled diabetes, there is a higher chance of being infected with ‘black fungus'.
“They can manifest in ones lungs, nose and sinuses which is the most common, while the fungal infection could also exhibit in ones eyes, brain and skin, which would lead to headache, facial pain and sinus congestion’’, he added.
Certain other results that could take place due to the fungal infection include that of pain in the eyes, loss of vision, swelling of cheeks and eyes or black crusts around the nose.
Management of ‘black fungus’
Prof. Seneviratne added that it is important to increase awareness of this infection while carrying out necessary tests at the appropriate time.
He added that it is essential to diagnose such fungal infection during the early stages and to ensure that diabetes is controlled while controlling corticosteroids steroids which should be used wisely and not be consumed in big doses for a prolonged period of time as it could increase the risk of this condition developing.
He added that early diagnosis is important as in such event there could be prompt intervention and you could ensure that that there is good blood pressure control, adding that anti-fungal treatment is necessary with the amphotericin drug.
Prof. Seneviratne added that in this condition there may also arise the need for urgent removal of dead tissues.
He further added that late diagnosis and limited access to treatment could lead to permanent damage including eye damage and brain damage and there may be a mortality rate of 50 per cent in these patients.
COVID-19 - associated Mucormycosis
Dr. Seneviratne said that in the event COVID-19 patients have diabetes and obesity, they are more likely to receive corticosteroids while in the hospital and both corticosteroids and diabetes increase the risk of mucormycosis and other fungal infection.
He added that COVID-19 can damage the airway tissue and blood vessels and increase the susceptibility to fungal infections so all these factors can act together and that could be driving the condition in places such as India.
Dr. Jayasekera further added that COVID-19 patients with diabetes and a weak immune system are more likely to be infected with the Black Fungus, such individuals should not wear a facemask for more than four hours at a time and should not reuse face masks after washing them.
Elaborating on the need to wear clean face masks, she added that wearing unclean masks would result in several other diseases not limited to Mucormycosis.
Globally, did ‘black fungus' exist prior to the COVID-19 pandemic?
Prof. Seneviratne said that prior to the COVID-19 Pandemic, Mucormycosis was very common in India while it was also identified in Australia.
He added that there have been global outbreaks of ‘black fungus’ through contaminated products including hospital linen, medications and packaged foods.
Prof. Seneviratne added that in a study done looking at the cases from 2000 to 2007, diabetes came as an important underlying risk factor that was identified in about 40 per cent of these patients.
‘Black fungus’ in India
While there has been over 9,000 black fungus associated COVID-19 cases detected in India, there has been over 250 deaths in both COVID-19 patients and those recovering and recovered from COVID-19.
As a country facing a surge in the number of COVID-19 cases and deaths, India reports a shortage in facilities and drugs to treat patients who have been detected with ‘black fungus’.
India’s official Health portal states that the prevalence of diabetes in the country is at 12 per cent to 18 per cent in the adult population specially in the urban areas.
According to ‘The Hindu’, without population based estimates, it is difficult to determine the exact incidence and prevalence of Mucormycosis in the Indian population but that a computational model based method has now estimated a prevalence of 0.14 cases per 1,000 individuals in India.
The infection however remained a possibility for one in ten thousands who recovered from Covid-19 according to ‘The Hindu’ and it was further stated that diabetes mellitus has been reported in 54 per cent to 76 per cent of cases
It was also stated that while the Fungi is present in the environment, the use of nasal prongs and other devices for oxygen delivery and possible breach of sterile conditions can possibly lead to cross infection and hospital-acquired infection in patients
According to BBC, the western States of Gujarat and Maharashtra have reported more than half of the reported cases and at least 15 more States have reported between eight and 900 cases. Following the rise in cases, India's 29 States have been told to declare the disease an epidemic.
BBC further stated that according to hospital sources, newly opened wards to treat patients suffering from the disease around the country are filling up fast
Thereby, although there is no COVID-19 - associated Mucormycosis cases reported in Sri Lanka at the moment, what is important to note is that this infection is not new to Sri Lanka which could be of a possible risk to COVID-19 patients due to the use of steroids, compromised immune system and a higher risk in patients with diabetes.
It is important that there is sufficient awareness of this infection as India which is a country that also had Mucormycosis cases prior to the COVID-19 pandemic were caught completely off guard with the increasing COVID-19 - associated Mucormycosis cases while battling a surge in the increase in the number of COVID-19 cases and deaths.