A study of the COVID-19 patients by a major hospital in New Delhi has led to some disturbing revelations, as the disease is now seen as triggering mucormycosis, a rare fungal infection, with high morbidity and mortality rate.
According to doctors at Sir Ganga Ram Hospital in Delhi, at least 10 cases of COVID-19 patients are known to have mucormycosis, or black fungus, with over 50% of those patients losing eyesight, as well as their nose and jaw bones.
Dr Manish Munjal, Senior ENT Surgeon, Sir Ganga Ram Hospital said that the frequency at which they are witnessing the occurrence “has never been seen before and is shocking and alarming.”
Doctors are currently seeing mortality in the range of 50% (5 patients), with certain deaths triggered with the involvement of brain, a statement issued by the hospital said.
Case Study
One such case was of Rajesh*, a 32-year-old businessman of West Delhi. He did not worry much about a bout of fever that stuck him on November 20, but for the sake of his elderly parents, and concern due to his mild diabetic condition, he got a Corona test done, which returned positive the next day.
The fever refused to break for 4 days and then lead to excessive cough and breathing problems, leading to a decline in his oxygen saturation levels. He was hospitalised and administered a cocktail of antiviral drugs, IV steroids, oxygen support and other supplements. Eventually, after testing negative for the virus, he was discharged from the hospital after seven days.
A nagging left side nose obstruction, which rapidly became an eye swelling two days later, made him reach the doctors again. But rather than responding to antibiotics and painkillers this time, Rajesh rapidly started losing vision on the affected side.
The whole left side of his face became numb and he was brought to the hospital emergency in a partially disoriented and obtunded state. His tests revealed the presence of steeply elevated sugar and infection levels, but even deadlier, the presence of a rare fungus called mucor, which was sampled from his nose debris.
An MRI scan revealed that the infection had already destroyed a significant part of his left side sinuses, eye, upper jaw bone and muscles, and had now made a passage into his brain.
Sir Ganga Ram’s Hospital’s ENT and eye surgeons’ team carried out an extensive surgical debridement. Rajesh was subsequently put on life-saving anti-fungal medication and vital critical care support for more than two weeks. He will soon be discharged in a survivable, but a disfigured state, said the statement.
Doctors say that while the course the fungus took is not new, but the fact that COVID-19 is triggering mucormycosis is.
Black fungus or mucormycosis has been a cause of disease and death in transplants, ICU and immunodeficient individuals since long. It is, however, the rapid increase in numbers seen in unsuspecting and so-called recovering patients that is a matter of grave concern.
The team of specialists at the hospital have already done these resections in about 10 patients over the last fortnight, with about 50% having lost their eyesight permanently.
“Five of these patients required critical care support due to associated complications. There have also been five unfortunate mortalities so far in this subgroup,” Dr Munjal said.
As a matter of utmost caution against the disease, Dr Munjal suggests that early clinical suspicion with symptoms such as nose obstruction, swelling in the eye or cheeks, and black dry crusts in the nose “should immediately prompt the conduct of a biopsy in the OPD and start of the antifungal therapy as early as possible”.
According to senior Eye Surgeon Dr Shaloo Bageja, orbital involvement is a grave development in the course of this disease. “It points not only towards the possibility of permanent loss of eyesight but life as well because brain involvement is the leading cause of death in mucormycosis,” she said.
Early diagnosis, however, requires early reporting. Dr Jasvinder Kaur, Clinical Mycologist at the Sir Ganga Ram Hospital, said, “Early identification by microscopy of the deadly aseptate mucor hyphae fungus in fresh specimens is the key to the start of appropriate antifungals.”
Doctors warn that reviving the immunocompetence of a weak COVID-19 patient is a herculean task. “We have to carefully elevate the dosages of antifungals to more than maximum (suprathreshold) levels, without letting the internal organs like kidney and liver facing the damage,” said Dr Prakash Shastri, Vice-Chairman for critical care at the hospital.