Decoding India’s fungal epidemic triggered by COVID-19

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Rise of fungal infections during the second COVID-19 wave

The second wave of COVID-19 in India has coincided with a sharp increase in the number of cases involving severe fungal infections. The rise in cases is being attributed to the susceptibility of COVID-19 patients to secondary infections. However, experts believe that a number of factors might be at play.

What is making COVID-19 patients more prone to fungal infections?

Weakened immune system, uncontrolled diabetes mellitus, poor oral and nasal hygiene, prolonged stay in ICU, overuse of steroids and immunomodulating drugs, voriconazole therapy, and co-morbidities like blood malignancies and post-organ transplant are some of the major factors that are believed to be making COVID-19 patients susceptible to fungal infections.

Confusion caused by color-coding of fungal infections

A lot of confusion has been caused by the color-coding of fungal infections being reported in India. Experts say the use of terms like black fungus, white fungus, and yellow fungus is a misnomer. They are asking people to refrain from using these terms and use the medical names instead.

Fungal infections affecting COVID-19 patients

According to the government data, the different fungal infections being observed in recovering and hospitalized COVID-19 patients are – Mucormycosis, Candidiasis, and Aspergillosis.

What is mucormycosis?

Mucormycosis has emerged as the most common fungal infection during the second COVID-19 wave. It is caused by exposure to a group of molds called mucormycetes. Without prompt treatment, it can lead to loss of the upper jaw or eye. The mortality rate of mucormycosis ranges between 40% and 80%.

Symptoms of mucormycosis

Common signs of mucormycosis include headache, cough, fever, chest pain, shortness of breath, blurry or double vision, nasal blockage or congestion, pain in sinuses, swelling on face, blackish or bloody discharge from the nose, lack of sensation on the face, blackish discoloration or lesions on the nasal bridge, etc.

What is candidiasis?

Candidiasis is a fungal infection that is caused by a type of fungus called Candida albicans. The fungus normally resides on the skin and inside the body without causing any major problems. However, in some cases, candida can cause severe infections if it grows out of control.

Symptoms of candidiasis: #1 - Vaginal candidiasis

The symptoms of vaginal candidiasis include itchiness or soreness in the vagina, pain during intercourse, pain or discomfort while urinating, and abnormal discharge from the vagina.

#2 - Candidiasis of mouth, throat, and esophagus

White patches inside the oral cavity, loss of taste, sore throat, pain while eating or swallowing, cotton-like feeling in the mouth, and cracking and redness at the corners of the mouth are some of the symptoms of the candidiasis of mouth, throat, and esophagus.

#3- Invasive candidiasis

Most of the symptoms of invasive candidiasis are similar to the underlying condition i.e. COVID-19. This includes fever, cough, pain in the chest, shortness of breath, and low oxygen saturation (despite testing negative for SARS-CoV-2 virus). The symptoms become severe as the infection spreads deeper inside the body.

What is aspergillosis?

Aspergillosis is a fungal infection that is caused by a type of mold called Aspergillus. It mostly affects people with weakened immune systems or lung diseases. In India, two types of aspergillosis cases are being observed in COVID-19 patients - bronchopulmonary aspergillosis and invasive aspergillosis.

Symptoms of aspergillosis

Some of the most common symptoms of aspergillosis include: Fever, cough, wheezing, runny nose, headache, chest pain, reduced ability to smell, coughing up blood (sometimes), and shortness of breath.

Treatment of fungal infections

Doctors are treating fungal infections with the help of prescription medications such as fluconazole, amphotericin B, posaconazole, isavuconazole, echinocandin, etc. They are also prescribing topical anti-fungal gels and ointments for oral and skin lesions. In severe cases, surgery is being done to remove the infected tissues.

Challenges posed by the fungal infections

The emergence of fungal infections has complicated the fight against the pandemic. At a time when hospitals are overflowing with COVID-19 patients, the requirement of separate wards for patients and lengthy anti-fungal treatments is proving to be challenging. The predicament is even more agonizing for some patients who have to undergo extensive life-changing surgeries.

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