States to Notify Black Fungus as Epidemic: Who is at High Risk?

The move comes after several states have reported cases of mucormycosis, commonly known as ‘black fungus’.

The Union Health Ministry on Thursday, 20 May urged the states to make mucormycosis, commonly known as black fungus, a notifiable disease under the Epidemic Diseases Act 1897.

“All government and private health facilities, medical colleges to follow guidelines for screening, diagnosis, management of mucormycosis, issued by MoHFW and ICMR,” the ministry said.

Under the act, all states will have to report all confirmed or suspected cases of this condition, seen in recovering COVID patients, to the health ministry. The infection has been recorded in several parts of the country.

The All India Institute of Medical Sciences (AIIMS) on 19 May released guidelines for early detection and prevention of mucormycosis in the hospital’s COVID Ward.

What is mucormycosis or black fungus?

According to the US Center for Disease Control and Prevention, mucormycosis is a serious but rare fungal infection caused by a group of molds called micromycetes.

“The fungus is freely present around us, but it needs a very specific kind of environment in someone’s body for it to get an opportunity to cause an infection,” Dr Aparna Mahajan told FIT.

“It is most commonly found in the nose, the sinuses, the eyes and the brain,” she said. “Once it spreads to the brain, it can be very difficult to treat.”

Who are at high risk?

Medical experts say that black fungus cases are being seen among COVID patients who were administered steroids to treat symptoms, and also among those who are suffering from diabetes and cancer.

According to AIIMS guidelines, the following category of people are under higher risk:

• Patients with uncontrolled diabetes, diabetic ketoacidosis, and diabetics on steroids or tocilizumab
• Those on immunosuppressants or anticancer treatment, and patients with chronic debilitating illness
• Patients on high dose steroids and or long duration of steroids or tocilizumab
• Severe COVID-19 cases
• Patients on oxygen support – and needed nasal prongs, by mask, or on ventilator

What are the symptoms that caretakers have to look out for?

• Abnormal black discharge or crust, or bleeding from the nose
• Nasal blockage
• Headache
• Eye pain
• Swelling around the eyes, double vision, redness of eye, loss of vision, difficulty in closing eye, inability to open the eye, prominence of eye
• Facial numbness or tingling sensation, difficulty in chewing or opening the mouth

Should these patients do self-examination even after discharge?

• Yes. Regular self-examination, including face examination in daylight, for facial swelling – especially nose, cheek, around the eye – or black discolouration, hardening, and pain on touch.
• They should also look for signs of black areas and swelling inside the mouth, palate, teeth, or nose.
• Oral and nasal examination using torchlight.
• AIIMS has directed and especially ophthalmologists to advise patients with high risk to do regular checkups with doctors even after discharge.

What must patients do if they experience any of the above symptoms?

• Patients must immediately consult an ENT doctor or ophthalmologist for their treatment.
• They should NOT self-medicate with steroids, antibiotics or antifungal drugs.
• Strict control and monitoring of diabetes.
• Regular treatment and follow-up with their doctors is a must.

Which states have reported black fungus cases?

• In the national capital, the administration on Thursday said that dedicated treatment centres for black fungus will be set up in three hospitals across Delhi after AIIMS reported that its seeing over 20 cases of the fungal disease on a daily basis.
• States including Rajasthan and Telangana have already listed the fungal infection as an epidemic.
• In Maharashtra, 1,500 cases and 90 deaths have been reported due to black fungus.
• Tamil Nadu, which has only recorded nine cases, has also notified the disease under its Public Health Act.