PGIMER, Chandigarh conducts first evidence-based mucormycosis study; finds direct link of fungal infection with steroids and diabetes

Even when the country witnessed a declining trend of Covid-19 cases, the threat of Mucormycosis or black fungus mostly for recovered patients is looming large on the healthcare system. With 20, 000 cases and a trail of bodies, this fungal infection bared that the authorities are still not prepared to handle it.

The mortality rate of black fungus is significantly higher than Covid’s viral infections making early diagnosis and prompt action that the most important need of the hour for saving a life.

However, as a matter of fact, cases of mucormycosis are not new to the second wave. Doctors of leading institutes of the country notice such infections even during the first wave. PGIMER, Chandigarh doctors recently conducted a study titled ‘MucoCovi’ (Muco from mucormycosis, Covi from Covid-19) at 16 centers in the country. The study established various facts about the average time for its diagnosis, symptoms, and even the section most vulnerable to the infection.

The findings of the study were published in the reputed Emerging Infectious Disease Journal (Journal of CDC, Atlanta, USA)

Dr. Arunaloke Chakrabarti, Professor, and Head of the Department of Medical Microbiology, PGI, one of the researchers informed that the study was conducted with mucormycosis cases occurring between September 1 and December 21, 2020, and found that the prevalence of Covid Associated Mucormycosis (CAM) was in among 0.27 percent patients managed at hospitals and 1.6 percent patients admitted at ICUs. There is a more than two-fold rise in cases in 2020 compared to 2019 suggesting that Covid-19 is responsible for the spike.

The study also found that on average it took 18 days after Covid-infection for a patient to be diagnoses with CAM. In 58% of cases, the infection occurred in the eyes and nose followed by brain involvement in 27% of cases and lung infection in 9 percent cases. A considerable number of patients reported to the hospital only after the infection progressed to their brains. Among the symptoms of the infection, the most prevalent are facial pain, nasal blockage, toothache, loosening of teeth, etc.

When CAM was compared with Non- Covid Mucormycosis cases, the study found that uncontrolled diabetes mellitus was one factor common in both groups. The study also found that Covid-19 worsens the condition of diabetes patients making them prone to mucormycosis. Patients with diabetic ketoacidosis were diagnosed with CAM as early as eight days of getting Covid infection. The patients who caught the fungal infection later were under steroids.

The study also observed how inappropriate use, either in high doses or unnecessarily cases CAM in later stages. The death rate is also high at 38.3 percent in the first six weeks and 45.7 percent of the infection persists after 12 weeks. Patients about 54 years of age when the infection has progressed to the brain or lungs and has been under ICU care have a higher risk of succumbing to the disease.

The study ‘Multicenter Epidemiologic Study of Coronavirus Disease-associated Mucormycosis, India’ was conducted with the aim of removing myths surrounding the emergency of black fungus cases. The study could not look into the role of Covid-19 in impacting immunity leading to mucormycosis but proved that uncontrolled diabetes and inappropriate use of steroids are most responsible for the emergence of the fungal infection.