Fungus colour should not lead to panic, look for causes and risks: Experts
Seeking to quell the alarm over rising cases of mucormycosis in Covid patients, epidemiologists on Tuesday underlined the importance of analysing the kind of fungal infection, its causes and risk factors and said the colour of the fungus should not lead to panic. Health Minister Harsh Vardhan on Monday said 18 states have reported 5,424 cases of mucormycosis, a life-threatening infection, among COVID-19 patients and those who recovered from it.
Beside black fungus cases, instances of white and yellow fungus infections have also been reported from different parts of the country recently, which scientists say are also mucormycosis.
Dr Samiran Panda, head of the Epidemiology and Communicable Diseases at the Indian Council of Medical Research (ICMR), said the use of "terms like black, green or yellow fungus" is making people scared and apprehensive.
Also, black fungus getting synonymous with the existing mucormycosis is complicating matters, he said.
"For common people," he told PTI, "I will say not to be driven by panic by colour -- black, yellow, white. Let us find what kind of fungal infection is the person infected with as most fungal infections that cause fatal or severe disease are invasive fungal infections… that can occur when there is reduction or compromise in immunity.
"So basic underlying phenomenon is immunity or the ability to fight the fungal infection," he said.
In Ghaziabad, a person was detected with three variants of the fungus -- black, white and yellow -- on May 24, claimed a doctor of a private hospital who is treating the 59-year-old patient in the NCR city in Uttar Pradesh.
Yellow fungus has been observed in reptiles, such as lizards, but not in human beings, claimed Dr B P Tyagi, an ENT (ear, nose, throat) specialist at Harsh Hospital in the town’s Raj Nagar area.
"The patient had come to me with conditions of extreme weakness, giddiness, fever and nasal discharge. The yellow fungus was detected during the endoscopy," the doctor told PTI.
"This is the first case of a person having three variants of the fungus -- black, white and yellow," he claimed.
He said the patient, a lawyer by profession, had COVID-19 but was in home isolation and approached the hospital after enduring these problems for eight to 10 days.
"He is under treatment now. There is nothing to worry about and the fungus would be removed. Had he come to me after one or two days, his problem would have been resolved by now," Tyagi said.
He said fungi attack people with compromised immunity and in this particular case, his patient is a diabetic.
Asked about the yellow fungus case, ICMR's Panda said the specimen has to be studied to ensure it indeed was yellow fungus seen in reptiles.
Dr Giridhara R Babu, the head of Life-course Epidemiology, Indian Institute of Public Health, said it is important to identify the cause and risk-factors associated with fungal infections.
"When a disease such as mucormycosis exists in a community, what kind of investigations are we doing? As an epidemiologist, I am interested in identifying the particular cause of it, then what is the set of causes that will result in a condition like this, the reason it was not seen in the first wave and it has been seen in the second wave only," he said.
Babu also said it needs to be understood why some people are more prone to the fungal infection and what is the reason behind rising cases.
"In the second wave, there are some unusual things happening which were not there in the first wave such as the use of industrial oxygen. There are also variants of coronavirus in the second wave," he said.
According to him, viral and fungal infections are always around, but most people don't get impacted because of their good immunity or the less infective nature of the virus or the fungus.
"...but if that changes, and they become more infective or our immunity reduces then we are at a higher risk. What I will definitely call for is one can buy tons of antifungal agents, but if you don't find what is the cause and risk-factors leading to this, then we will not be able to solve it. I think that is where we should focus as a country," he said.
AIIMS Director Randeep Guleria has also said it is better to identify mucormycosis by its name rather than by the colour.
"Labelling the same fungus with names of different colours can create confusion. Mucormycosis is not a communicable disease, unlike COVID-19. About 90-95 per cent of patients getting infected with mucormycosis are found to have been either diabetic and/or taking steroids. This infection is seen very rarely in those who are neither diabetic nor taking steroids," he told reporters recently.
He had said in general, there are various types of fungal infections such as candida, aspergillosis, cryptococcus, histoplasmosis and coccidioidomycosis.
Mucormycosis, candida and aspergillosis are the ones observed more in those with low immunity, he said.
Guleria had also said no definite link of mucormycosis has been seen with oxygen therapy.
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