A patient with black fungal infection patient at the mucormycosis ward of a government hospital in Hyderabad, May 19, 2021. Photo: PTI
New Delhi: The Union health ministry has urged the states and Union Territories to make cases of black fungal infection or mucormycosis a notifiable disease under the Epidemic Diseases Act, 1897, stating that the infection is leading to prolonged morbidity and mortality among COVID-19 patients.
In a letter, the ministry said in recent times, a new challenge in the form of a fungal infection ‒ mucormycosis ‒ has emerged and has been reported among COVID-19 patients in many states, especially those on steroid therapy and deranged sugar control.
“This fungal infection is leading to prolonged morbidity and mortality among COVID-19 patients,” joint secretary in the ministry, Lav Agarwal, said in the letter.
The treatment of this infection requires a multi-disciplinary approach consisting of eye surgeons, ENT specialists, general surgeons, neurosurgeons and dental maxillofacial surgeons, among others, and the institution of the Amphotericin-B injection as an antifungal medicine.
“You are requested to make mucormycosis a notifiable disease under the Epidemic Diseases Act, 1897, wherein all government and private health facilities, medical colleges will follow the guidelines for screening, diagnosis, management of mucormycosis issued by the Ministry of Health and Family Welfare and the Indian Council of Medical Research (ICMR).
“And, make it mandatory for all these facilities to report all suspected and confirmed cases to the health department through the district-level chief medical officers and subsequently, to the Integrated Disease Surveillance Programme (IDSP),” the letter stated.
Meanwhile, the Indian Medical Association (IMA) has written to Prime Minister Narendra Modi, urging him to allow the eligible pharmaceutical companies to manufacture Amphotericin-B in the country.
“At this moment, we wish to bring to your kind notice an issue we are facing in the clinical management on the raising incidents of the black fungus mucormycosis. As the patients who are either diabetic or immunocompromised need to take steroids as per the treatment protocols and are subjected to continuous oxygen support therapy, they are becoming more prone for this dreaded disease,” the IMA said in its letter.
It is an acute angioinvasive fungal disease that needs emergency treatment with local debridement and systemic Amphotericin-B drugs, it said.
The IMA highlighted that though last year, the DCGI had given permission to a few Indian pharmaceutical firms to manufacture Amphotericin-B, it was withdrawn subsequently.
“Now, only a US-based company has the licence to import the drug in India and there is no indigenous production, resulting in an acute shortage of this drug. On behalf of the IMA, we appeal and beseech your kind personal intervention to direct the DCGI to give the emergency or short-term permission for the eligible pharmaceuticals to manufacture the drug in our country,” the association’s national president, Dr J.A. Jayalal, said in the letter.
Health minister Harsh Vardhan cautioned people on Wednesday against excessive use of steroids.
He said people are taking heavy doses of steroids even when they have not turned hypoxic.
“Steroids are to be provided only when a patient is hypoxic, to be administered in small doses to prevent side-effects and not for more than a few days at a stretch,” he said.
The health ministry last week said the disease is being detected among patients who are recovering or have recovered from COVID-19. Moreover, anyone who is diabetic and whose immune system is not functioning well needs to be on the guard against it.
According to the ICMR, conditions such as uncontrolled diabetes, weakening of the immune system due to the use of steroids, prolonged ICU or hospital stay, comorbidities or post organ transplant or cancer, voriconazole therapy (used to treat serious fungal infections) in COVID-19 patients increase the risk of mucormycosis.
The disease is caused by a set of micro-organisms known as mucormycetes, which are present naturally in the environment, seen mostly in soil and in decaying organic matter like leaves, compost and piles.
“In normal course, our body’s immune system successfully fights such fungal infections. However, we know that COVID-19 affects our immune system. Moreover, the treatment of COVID-19 patients involves intake of drugs like dexamethasone, which suppress our immune system response. Due to these factors, COVID-19 patients face a renewed risk of failing the battle against attacks mounted by organisms such as mucormycetes,” the ministry had said.
In addition, COVID-19 patients undergoing oxygen therapy in the ICU, where a humidifier is used, are prone to fungal infections because of exposure to moisture.
The disease is uncommon in those not having diabetes but can be fatal if not treated promptly. The chances of recovery depend upon early diagnosis and treatment.
Mucormycosis begins to manifest as a skin infection in the air pockets located behind the forehead, nose, cheekbones and in between the eyes and teeth. It then spreads to the eyes, lungs and can even spread to the brain. It leads to blackening or discolouration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing of blood.
Agarwal said the Centre has told the states that whenever a mucormycosis case is reported, it must be notified to the public health network so that it can be consolidated and the related screening diagnosis and management guidelines issued by the government must be followed.