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India has ordered tighter surveillance of a rare fungal disease hitting Covid-19 patients, officials said on Thursday, piling pressure on hospitals struggling with the world’s highest number of daily infections of the novel coronavirus.

Mucormycosis, or “black fungus”, usually infects people whose immune system has been compromised, causing blackening or discolouration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood.

Doctors believe that the use of steroids to treat severe Covid-19 could be causing the rash of cases because those drugs reduce immunity and push up sugar levels.

The health secretary, Lav Agarwal, said in a letter to state governments that mucormycosis had emerged as a new challenge for Covid-19 patients on steroid therapy and those with pre-existing diabetes.

“This fungal infection is leading to prolonged morbidity and mortality among Covid-19 patients,” he said in the letter reviewed by Reuters on Thursday.

He gave no numbers of the mucormycosis cases nationwide but Maharashtra, one of the states worst hit in the second wave of coronavirus infections, has reported 1,500 cases.

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