A host of black, yellow and white fungal infections have been reported in India among Covid-19 survivors, leading to fears of an “epidemic within a pandemic” in a country hit by a deadly second wave that has affected millions of people.
Although there is no official tally of fatalities in the public domain yet, according to the Associated Press, local media have recorded more than 250 deaths due to black fungus.
Two other types of infections — white fungus, or candidiasis, and yellow fungus, which belongs to the family of mucormycosis — have also emerged among recovered Covid-19 patients.
Experts say these fungal infections aren’t new, however, the rate at which they are developing among Covid-19 patients is alarming. And because of the large number of people afflicted with Covid-19, an acute shortage of the drugs used to treat the fungus has also been reported.
The Independent spoke to Dr Sumit Ray, head of critical care at Delhi’s Holy Family hospital, which has treated a number of cases of fungal infections in Covid patients, to understand these infections, their symptoms, treatment, and why Covid-19 patients are more prone to it.
Difference between black, white and yellow fungus
“Black fungus or mucormycosis is a type of fungi which are called moulds,” Dr Ray explained. “We are all exposed to these on a daily basis but do not get affected unless we are significantly immunocompromised or immunosuppressed.”
Black fungus, which, among others, causes a rhino-cerebral infection, has a mortality rate of 50 per cent even after treatment, according to Dr Ray. A second type of mucormycosis that is being observed in India is of the skin, which is easier to treat, but dangerous if it spreads to other organs.
Candidiasis, of which four cases have been reported so far, is a more common type of fungus that could grow in intensive care units at hospitals and is treatable by commonly available medicines, Dr Ray said. However, on Thursday, Delhi’s Ganga Ram Hospital reported the first-of-its-kind white fungus where multiple perforations were found throughout the intestine.
The yellow fungus infection is also a form of mucor that is rarer than black fungus. It grows in similar settings as the black fungus and its treatment remains the same.
Dr BP Tyagi, an ENT specialist, who diagnosed the first case of yellow fungus in Ghaziabad, told The Independent: “The patient who was diagnosed with the infection was admitted with extreme fatigue, fever, cough, eye swelling.”
Though not much is known about white and yellow fungus in relation to Covid-19, experts have said the colour depends on growth of the fungus and it is “better to not identify them with colour.”
Connection of fungal infections and Covid-19
The fungal infections are especially evident in patients with co-morbidities and overuse of steroid treatment, Dr Ray said.
Due to a lack of hospital beds during the second wave, several patients, even those with diabetes and other co-morbidities, were prescribed steroids at home. “Their monitoring was not happening as well as it would happen at a hospital... the possibilities of such infections increased,” Dr Ray said.
“Don’t start looking for symptoms if you are not a person who can be prone to this infection, 99.9 per cent of Covid patients will not get it, it’s not related to coronavirus itself,” he reassured.
How much steroid use is safe?
“Steroids are important in our battle against Covid-19 when a patient is hospitalised and needs oxygen or in severely sick patients,” he said.
“Usually when the patient does not require oxygen, steroid use for five days is more than enough when needed,” he said. “Even those on a minimal amount of oxygen require a pretty low dose, higher dose are for only for those who are on ventilators or have high requirement of oxygen.”
What are the symptoms of fungal infections in Covid-19 patients?
Some common symptoms of black fungus include high fever, severe headache, nasal discharge or blurring of vision. According to Dr Ray, rhino-cerebral mucormycosis begins from the sinus and affects the brain, which causes these symptoms. It can also lead to loss of eyesight in some cases.
Another rare type of black fungus is the disseminated mucormycosis, which spreads through the bloodstream and can affect the organs. However, it occurs usually during transplant surgeries in severely ill patients. Its symptoms include visible black spots on the skin, among other symptoms like fever and extreme fatigue.
The common type of white fungus can be seen as a white layer on the tongue, particularly when patients use steroids through inhalers.
“You should wash your mouth well after taking inhalers or else it leaves a steroid coating in your mouth or your tongue and that can lead to white fungus or oral candidiasis,” Dr Ray cautioned.
After the first case of yellow fungus was detected, experts said it can be more dangerous since it starts internally, and could cause pus leakage or lead to slow healing of wounds. Its symptoms included lack of appetite, lethargy, sunken eyes, among others.
However, according to Dr Ray, it is treatable in similar ways as the black fungus as it belonged to the family of mucormycosis, but more studies are needed to understand it.