Amid the disastrous second wave of COVID- 19, another emerging major challenge is Black Fungus or mucormycosis which is a serious but rare fungal infectious disease.Mucormycosis is caused by a group of molds called mucormycetes. Given its fatal and infectious nature, all the states and Union Territories (UTs) have been asked by the Union Health Ministry to declare it as a notifiable disease under the Epidemic Disease Act 1897. This fungal infection has been seen as the most troubling trend of the second wave of the novel coronavirus in India. As of 21st of May 2021, around 10,000 cases of fungal infection have been reported officially.Telangana and Rajasthan have already declared mucormycosis as an epidemic.States like Karnataka, Uttarakhand, Telangana, Madhya Pradesh, Andhra Pradesh, Haryana and Bihar have reported many cases of mucormycosis. Mucormycosis is of various types including Rhinocerebral, Pulmonary, Gastrointestinal, Cutaneous, Cutaneous and Disseminated Mucormycosis. The commonest of all these types is rhino orbital- cerebral mucormycosis. Rhinocerebral Mucormycosis is an infection in the sinuses that can spread to the brain. It is the most common in people with uncontrolled diabetes and in people who have had a kidney transplant. Transmission of mucormycosis occurs through inhalation, inoculation, or ingestion of spores from the environment. It usually occurs in people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. The common symptoms of mucormycosis include headache, nasal or sinus congestion, black lesions on nasal bridge or upper inside of the mouth, fever,one-sided facial swelling and numbness, abdominal pain, gastrointestinal bleeding and nausea. For Diagnosis and Testing symptoms, physical examinations, laboratory tests and medical history are taken into consideration. A sample of fluid is collected from the respiratory system or a tissue biopsy is performed. In tissue biopsy, a small sample of affected tissue is analysed in a laboratory for evidence of mucormycosis under a microscope or in a fungal culture.
Amphotericin B is an antifungal medication used for serious fungal infections including Mucormycosis. It often requires surgery to cut away the infected tissue. At present no vaccine is available to prevent mucormycosis and it is difficult to avoid breathing in fungal spores because the fungi are common in the environment. As a preventive measure we should avoid areas with a lot of dust like construction or excavation sites, avoiding direct contact with water-damaged buildings and flood water after hurricanes and natural disasters and avoiding activities that involve close contact to soil.Use masks if you are visiting dusty construction sites. Wear shoes, long trousers, long-sleeved shirts and gloves while gardening. Maintain personal hygiene including a thorough scrub bath. Amid outbreak, AIIMS director lists three key factors to prevent ‘black fungus’ According to Dr. Guleria the first and foremost, the patient’s blood sugar levels should be strictly monitored. Secondly, in case of steroids have been prescribed to the patient, the blood sugar should be checked at a regular interval. Lastly, one should be very careful about the intake of steroids. Any steroid must be taken under medical supervision with a special focus on the dosage. In order to detect black fungus infection danger signs of Covid recovered patients need to be watched out.These danger signs include: Facial numbness or tingling sensation,Difficulty in chewing or opening mouth, Abnormal black discharge or crust or blood from the nose, Nasal blockage, headache or 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 the eye, hardening, and pain on touch, loosening of teeth. Black areas and swelling inside the mouth, palate, teeth or nose. A set of guidelines have been issued by the AIIMS for detection of black fungus in a patient. These guidelines are:
a) Immediate consultation with an the ophthalmologist or an ENT doctor.
b) Regular treatment and follow-up. Strict control and monitoring of blood sugar in diabetics
c) No self-medication with steroids or antibiotics or antifungal drugs
d) Regular medications and follow-up for other comorbidities
India has poor health care facilities compared to other developing countries including Pakistan and Bangladesh.According to the World bank data, India had 85.7 physicians per 100000 people in 2017 ( in contrast to 98 in Pakistan, 58 in Bangladesh, 100 in Sri Lanka and 241 in Japan).53 beds in per 100000 people ( in contrast to 63 Pakistan, 69.5 in Bangladesh,415 in Sri Lanka and 1298 in Japan).172.7 nurses and midwives per 100000 people. Health is a State subject in India and State spending constitutes 68.6% of all the government health expenditure. Owing to the emerging challenges in health sector, need of the day is to expand and improve the health infrastructure in India. Health being a state subject needs a close cooperation and coordination between the centre and the states.
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