6 things to know about 'black fungus' infections among India's COVID-19 patients

While India has only reported a few cases of Mucormycosis, a deadly infection known as "black fungus," across the last decade, tens of thousands have surfaced within the last month as the country faces the world's most severe COVID-19 outbreak, USA Today reported May 12. 

"We've seen this skyrocket in recent weeks," said Bhakti Hansoti, PhD, associate professor in the department of emergency medicine and international health at Baltimore-based Johns Hopkins Bloomberg School of Public health. "It consumes a lot of resources especially during this pandemic right now in India where healthcare resources are stretched at the limit," she told USA Today. 

Six things to know about the fungal infection: 

1. Mucormycosis is caused by Mucormycetes, a group of molds that live in soil and decaying organic matter. While rare, the exact number of U.S. cases is unknown because the country does not require national surveillance of the infection. 

2. Among COVID-19 patients in India, rhinocerebral mucormycosis, which starts in the sinuses and can spread to the brain, has been the most common form of the infection. This type of the infection has a mortality rate of 46 percent, while those with mucormycosis that has spread through the bloodstream to other parts of the body has a death rate of 96 percent, according to the CDC.

3, Rhinocerebral mucormycosis occurs most frequently in people with uncontrolled diabetes, a possible explanation of why there's been an influx of cases in India. "The Indian population has a high prevalence of uncontrolled diabetes due to the lack of routine screening," Dr. Hansoti said. "Up to 75 percent of mucormycosis cases occur among COVID-19 patients with diabetes," nearly half of which were previously undiagnosed until showing up to the hospital with mucormycosis symptoms, she added.  

4. Symptoms of rhinocerebral mucormycosis include one-sided facial swelling, headache, nasal or sinus congestion, black lesions on the nasal bridge or upper inside of the mouth, and fever. Symptoms have typically appeared two to three weeks after COVID-19 infection among patients in India who've developed the fungal infection. To prevent the infection from spreading to the brain, some patients have undergone surgery to have an eye removed. 

5. Immune-supressing steroids, prescribed to reduce COVID-19 induced inflammation, can leave people vulnerable to fungal infections. As India faces an oxygen shortage, many COVID-19 patients with breathing issues have been prescribed steroids, likely tied to the increase in mucormycosis infections there, experts told USA Today.

6. While mucormycosis is less common outside of India, a different type of fungal infection, Aspergillosis, has surfaced among a small number of COVID-19 patients in the U.S., according to USA Today. It's caused by Aspergillus, a common mold that lives indoors and outdoors, with a one-year survival rate of 59 percent, according to a 2018 study from the CDC. While rare, the CDC does not list an exact number of cases among U.S. COVID-19 patients. 


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