Now, white fungus haunts Covid patients

New Delhi As India grapples with alarmingly rising cases of the Black Fungus (Mucormycosis disease) after battling severe oxygen shortage amidst the second wave of the pandemic, the heath fraternity is now concerned with white fungus which is being reported among Covid-recovered patients who are on long-term steroid use and suffer from severe uncontrolled diabetes, among other conditions.

White Fungus has generally been seen in immuno-compromised people like those on chemotherapy or undergoing bone marrow transplant. Covid-19 itself is a condition which predisposes body to other added infections via use of high-dose steroids, broad spectrum antibiotics, monoclonal antibodies and industrial oxygen, which can carry mucor during non-sterilised equipment for humidification.

Now, a case of White Fungus has been found in a Covid-recovered patient from Mau district in Uttar Pradesh, and the health fraternity fear that many such cases are going unreported. "White Fungus usually referred as to infection from Candidiasis. It is usually seen as an opportunistic infection among immunocompromised host such as patients with HIV, on anti-cancer therapy, on long-term steroid use or severe uncontrolled diabetes," said Harshal R. Salve, Associate Professor at the Centre for Community Medicine, AIIMS, New Delhi.

According to Pratibha Dogra, senior pulmonologist from W Pratiksha Hospital in Gurugram, first signs or symptoms could be severe headache and pain in the sinus area, blackish growth or discharge from nose. "Diagnosis is simple through routine microscopic sample of mucor growth. If not diagnosed early, it has mortality of over 50 per cent," she said.

The White Fungus is a condition that may affect not just Covid patients, but any patient with a significant impairment of immunity. "The increased incidents of multi-drug resistant, lethal Candida infections (even in the immunocompetent) had become a growing challenge in healthcare even prior to the Covid pandemic," said Ranjit Mohan, Consultant -Internal Medicine, Infectious Diseases, Manipal Hospitals. The use of steroid medications may predispose to the development of fungal infections.

"This is because steroids simultaneously cause immune suppression as well as elevation in blood sugar levels, creating a favourable condition for fungal growth. Prolonged intravenous steroid therapy increases the chances of fungal infections," Mohan suggested. This condition is most frequently encountered among diabetics and among the elderly. "Also, a great incidence is noted when Covid 19 infections occur in patients with pre-existing immune deficiencies," Mohan said.

Treatment for White Fungus is Amphotericin B and Voriconazole while Echinocandins and posaconazole medicines can also be used. "Better immunity, good glycemic control, rational steroid use and maintaining personal hygiene and adequate indoor ventilation are keys to prevent this disease," Salve said.