black fungus
© PTIDoctors performing a Diagnostic Nasal Endoscopy to detect black fungus in a patient at a hospital in Jabalpur on Saturday
A study on black fungus involving 210 patients found that antibiotics were used to treat 100 per cent of these Covid-19 patients, who were later diagnosed with mucormycosis. Antiobiotics - Azithromycin, Doxycycline and Carbapenems - being prescribed for Covid patients in India, are known to increase the risk of fungal infections.

Authored by Dr VP Pandey, head of medicine at the state-run Maharaja Yeshwantrao Hospital in MP's Indore, the study also reveals that steroids were used in the treatment of only 14 per cent of the respondents.

While attributing the surge in cases of mucormycosis to the disproportionate use of steroids in Covid treatment, the Health Ministry is scaling up anti-fungal treatment to deal with the epidemic.

Mucormycosis or black fungus has emerged as a cause for concern, with a number of states declaring it an epidemic. Nearly 9,000 confirmed cases of the rare disease have been reported from across the country, mostly in recovered Covid-19 patients.

Comment: So is it the treatments or is it possibly tied to suffering severe effects of the coronavirus itself? Brain scans of Covid-19 patients show whole spectrum of strange, inexplicable neurological effects

'78.9 per cent of mucormycosis patients were men'

A separate study on black fungus indicates that mortality among patients of mucormycosis was 30 per cent. Dr Anoop Mishra, a co-author of the study, says this is much less than 50-60 per cent as reported earlier.
black fungus
© PTIA doctor checking a black fungus patient at a hospital in Hyderabad on Saturday
"In this paper, we have collated data on all the cases of mucormycosis in the world starting from the beginning of the Covid-19 epidemic," said Dr Mishra. Out of the 101 cases of black fungus analysed for the paper, 82 were from India.

The study also found that 78.9 per cent of mucormycosis patients were men. In addition, 59 per cent of the cases of black fungus were reported among patients in the hospital and 41 per cent among discharged patients.

Comment: This is interesting considering the different impact coronavirus - and other infections - have on men and women: Sex differences in immune responses to viral infection

Diabetes - black fungus

According to the study conducted by Dr VP Pandey, 21 per cent of the 210 black fungus patients were not even diabetic.

Diabetes, along with other comorbidities, has been identified as another common factor among mucormycosis patients.

Comment: Notably it's multiple comorbidities that puts one most at risk when infected with the coronavirus.

black fungus
© PTIDoctors treating a black fungus patient at a hospital in Jabalpur on Saturday
Similarly, the study published by Dr Anoop Mishra and his team indicates that 80 per cent of black fungus patients were afflicted with pre-existing diabetes mellitus (DM).

At the same time, only 14.9 per cent of the 101 patients had concomitant diabetic ketoacidosis (DKA). What is interesting is that 20 per cent of the patients infected with black fungus were not even diabetic, as per the study titled 'Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India'.

Excessive steam could lead to black fungus

Data also shows that as many as 10-20 per cent of the cases of mucormycosis previously reported in India were associated with burns. Trauma to the skin (or mucous membrane) can trigger invasive fungal infection in the right settings.

Former president of the Kochi chapter of the Indian Medical Association (IMA), Dr Rajeev Jayadevan, says excessive steam inhalation could be another factor behind the rise in cases of black fungus.

He explains: "There is a delicate mucous layer that protects us from bacteria and viruses and this is a slimy layer that can be destroyed by large amounts of steam."

"High temperature steam in large amounts taken excessively can damage the mucosa, the lining of the airways," Dr Jayadevan told India Today.

Dr Jayadevan adds, "Steam inhalation may seem like a benign process but there is no scientific basis that it will help in Covid-19 apart from slight symptomatic relief in cases of dry cough."

Black fungus cases rose by 2.5 times last year

Cases of black fungus went up by 2.5 times across 16 centres in India between September and December of last year, a research paper published in the medical journal Microorganisms pointed out.

The paper, compiled by Professor Marco Falcone from the University of Pisa in Italy, said, "The computational-model-based method estimated a prevalence of 14 cases per 1,00,000 individuals in India."

black fungus
© PTIA doctor checking a patient for black fungus at a hospital in Navi Mumbai on Saturday
Globally, the prevalence of mucormycosis varied from 0.005 to 1.7 per million population. At the same time, its prevalence is nearly 80 times higher (0.14 per 1,000) in India compared to developed countries, according to a recent estimate from 2019-2020.

Another study, published in Diabetes and Metabolic Syndrome: Clinical Research and Reviews, suggests that the unholy trinity of diabetes, rampant use of corticosteroids coupled with Covid-19 infections appears to have led to the rise in cases of black fungus in the country.

The Diabetes and Metabolic Syndrome: Clinical Research and Reviews is the official journal of DiabetesIndia and the National Diabetes, Obesity and Cholesterol Foundation (NDOC).