SMCH starts "Black Fungus" treatment on the suspected patient; "No reason to panic," MP Rajdeep Roy

A medical team of specialists from the ENT, Opthalmology, Medicine, Dermatology, and Microbiology departments have been constituted to treat a patient who is suspected to have got infected by the Black Fungus causing Mucormycosis. The patient hails from Karimganj and is currently undergoing treatment at Silchar Medical College and Hospital. He had tested positive for COVID 19 on May 5 and was admitted to Civil Hospital Karimganj.

12 hours after an official in Cachar District Administration erroneously declared that there is a case of “Black Fungus” in SMCH, the Principal Dr. Babul Bezbaruah, member of parliament, Dr. Rajdeep Roy, and deputy commissioner of Cachar jointly called for a press conference earlier today to share more details about the patient. The Principal, at the very beginning, made it clear that they do not have all necessary reports yet to declare that the patient is indeed infected by Black Fungus.

“To declare that the patient is infected by the Black Fungus we need to have the Culture report and the Biopsy report, both are awaited and so we cannot declare it yet. The declaration yesterday was illegal and unauthorised,” said Dr. Bezbaruah.

Though crucial reports are still awaited, looking at the condition of the patient and the preliminary reports including MRI, we have decided to go ahead with the treatment assuming it as a case of Black Fungus infection,” Dr. Babul Bezbaruah.

However, KOH test (potassium hydroxide preparation), which is a preliminary examination suggests that it could indeed be a case of Mucormycosis, first among patients who have recovered from COVID. The patient has been kept at a cabin in the Medicine department and is under the treatment of the special team. After getting discharged from Karimganj Civil Hospital on May 11, he developed breathing difficulties on May 12 and took admission to a private nursing home. From there he was discharged on May 15 and stayed at a lodge for a day. On May 17, he took admission to another private hospital with the same respiratory issue and went to SMCH on May 26.

The Principal informed that the patient was initially admitted to the Opthalmology department as he had a problem with his eye. “There he was examined and a nasal involvement was noticed. The case was referred to ENT within SMCH where the doctors took his samples. Though crucial reports are still awaited, looking at the condition of the patient and the preliminary reports including MRI, we have decided to go ahead with the treatment assuming it as a case of Black Fungus infection,” added Dr. Bezbaruah.

The member of parliament, Dr. Rajdeep Roy urged the general public to not get confused. “There is no reason to panic as there is treatment available,” said the MP. He added, “Black Fungus or Mucormycosis is a common disease that we see in the April to September season in this region and are treated in the Out Patient Department by the doctors. Yes, it becomes critical for the patients with comorbidities of immunodeficiency.”

With the rise in cases during the second wave, secondary bacterial and fungal infections after making covid recovery have also increased manifold. Black fungal infections termed as Mucormycosis are also on the rise in cities like Mumbai, Delhi, parts of Rajasthan, and in pockets across the country. The black fungal infection was seen during the previous wave as well however the frequency has increased this time in proportion to the gigantic rise in covid cases.

As per Vice Principal of SMCH Dr. Bhaskar Gupta who is as Professor and Head of Department, Dermatology, Leprosy and Sexually Transmitted Diseases (STD), “Black fungal cases are mainly seen in individuals who are on immunosuppressive drugs and have a prolonged hospital stay due to Covid. The black fungus is present in the environment and it won’t affect a normal person having a good immune system. During Covid, people usually recover in a short span of time without much medical intervention. However, when steroids and medications like Tocilizumab are used for controlling the cytokine storm in severe covid cases, the fungus may opportunistically infect those individuals sometimes.”

“We have doses of Amphotericin B3, enough drug for the next three days,” MP Dr. Rajdeep Roy

Basically, cytokines are small signaling molecules or proteins which mediate and regulate immunity in the body. While fighting off a severe coronavirus infection, in some individuals, a cytokine storm may set in when the body goes into self-destruct mode killing its own cells in the process. It fails the ability to distinguish between healthy and infected cells in an urge to completely wipe off the infection leading to multi-organ failure and Acute Respiratory Distress Syndrome (ARDS).

In the case of this particular patient from Karimganj, he too complained of respiratory distress and took admission to a private hospital on May 12 a day after discharge from Karimghanj Civil Hospital. When asked about the Medical history of this patient and details about steroid usage, member of Parliament. Dr. Rajdeep Roy said that the details are there with the medical team and respecting the privacy of the patient, they wouldn’t want to reveal it at this stage.

Roy confirmed that anti-fungal treatment has already started. “We have doses of Amphotericin B3, enough drug for the next three days. Depending on the bodyweight of the patient, the team of specialist doctors will decide on the dosage and the same will be made available,” he said.

Recovered covid patients who were on steroids or immunosuppressive drugs should watch out for Black Fungus symptoms. Special care should also be taken in the case of patients who’re diabetic. Besides, there should be a clean hospital environment for preventing fungal infection. If non-sterile water is used in a humidifier bottle connected to an oxygen tube then loads of micro-organism can grow into it and pass inside the body, causing infection in immune-compromised patients. When asked if the patient was on industrial Oxygen and if the quality of oxygen supplied will be checked, the deputy commissioner of Cachar, Keerthi Jalli said, “Yes, we are looking into the matter. We have been speaking with all the Oxygen suppliers and are in touch with the private nursing homes in the district.”

Rajdeep Roy added that the Oxygen supplied to most of the hospitals comes from the same or similar source(s). Specialists across the country are investigating if industrial oxygen is one of the reasons behind the growth of Black Fungus cases in India.

“In 2013 a case of mucormycosis was treated at SMCH. The patient was highly diabetic and was presented to the SMCH. The patient responded to the treatment and recovered,” Dr. Bhaskar Gupta.

The symptoms of Black Fungus include One-sided facial swelling or paralysis, headache, nasal or sinus congestion, Black lesions on nasal bridge or upper inside of the mouth that quickly become more severe, not being able to see with eye/(s). The secondary fungal disease is more severe than covid with a mortality as high as 50%. If left untreated and can lead to serious life-threatening complications. The eyesight might get impaired for life and surgery might have to be performed for removing nose or jawbone for stopping its spread to vital organs like the brain. Only early detection and immediate treatment can help minimise it’s impact. Dr. Babul Bezbaruah said the patient from Karimganj has come to the SMCH late. “As per protocol, we need to operate and remove an eye that has got involved in order to save the other eye. There is a nerve connecting the brain which has also got involved along with the nose. The patient is on oxygen therapy and not in the condition to undergo surgery. The special team is looking into the matter,” added Dr. Bezbaruah.

Though this is the first case of mucormycosis among COVID survivors, in 2013 a case of mucormycosis was treated at SMCH, informs Dr. Bhaskar Gupta. “The patient was highly diabetic and was presented to the SMCH. The patient responded to the treatment and recovered,” said Dr. Gupta.

The nose, eye, and part of the brain, that mean the infection has spread over a period of time. Here the question arises, though the patient was brought to SMCH on May 27, he was under the treatment at hospitals since May 5, why none of the three hospitals could diagnose the case early. Across the country, the doctors are advising patients to report early as fatality is high among patients arriving late to the hospital. But he was in the hospital throughout. Do we not have the facility to diagnose or culture a black fungus case? MP Rajdeep Roy said, “Yes we do.” Yet why we could only diagnose after the infection has widely spread, remains subject to technical as well as medical investigation.