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The figure is staggering: around 12,000 patients have been diagnosed with a disease called “black fungus” in India, most of them sick who are recovering from covid-19.
This rare infection can be fatal, with a death rate close to 50%. A figure that worries not only the scientific world, but all the communities where cases have occurred (one, for example, was recorded the previous week in Uruguay).
Now doctors are starting to draw important conclusions about the reasons for their occurrence.
Among the advances, it is noteworthy that cases in India may have increased exponentially due to the high prevalence of diabetes recorded in the country.
However, this is not the only factor to take into account and for that it is worth checking out what is happening in other countries.
Before the start of the covid-19 pandemic, at least 38 countries had reported cases of mucormycosis or black fungus in their territory.
India and Pakistan have the highest rates, with around 140 cases per million per year according to Leading International Fungal Education (IDF).
A special mucormycosis ward in a hospital in the Indian state of Gujarat.
Dr David Denning of the University of Manchester and an expert on fungal infections said reported cases of “black fungus” in India were “much more massive than in other parts of the world” long before the pandemic.
“Mucormycosis is strongly linked to poorly controlled diabetes and there is a lot of (diabetes) in India.”
To this statement is added a piece of information: according to a survey of patients recovering from covid-19 around the world, 94% of those who have suffered a case of “black fungus” infection suffer from diabetes.
And most of those cases, 71%, were reported in India.
It’s possible. In countries with the highest number of cases of diabetes per capita outside of India, cases of “black fungus” have been reported.
Neighbors of India, Pakistan and Bangladesh also have a high prevalence of diabetes in their populations and have had cases of “black fungus”, but their numbers are not that high.
Doctors in Bangladesh have treated a confirmed case of mucormycosis and are awaiting the results of another suspected case.
Yes, doctors confirmed to the BBC that both patients had diabetes.
Pakistan has also reported five cases of mucormycosis in recent weeks and four of them have died, with data released as of May 12.
Brazil has reported 29 cases, but it’s not clear whether the patients had covid or diabetes.
Russia has also reported isolated cases of mucormycosis in patients with covid-19, but there are also no concrete figures on the total number of people detected.
On the other hand, the United States has one of the highest rates of diabetes in the world, with 9.3% of the population affected, and also has one of the highest rates of covid-19 infection. high levels of the planet.
But there, mucormycosis is very rare. Perhaps because most cases of diabetes are treated and only 3% go undiagnosed, according to data from the Centers for Disease Control and Prevention (CDC).
Beyond reported diabetes cases, experts say the other issue they face is the difficulty of establishing previously undiagnosed cases of diabetes.
A woman undergoing an eye exam at a hospital in Mumbai.
The IDF estimates that around 57% of people with diabetes in India, Nepal and Bangladesh go undiagnosed. And about half of them are in India.
“There is a lot of uncontrolled diabetes in India because people don’t get regular check-ups,” says Hariprasath Prakash of the Kyrgyz International School of Medicine.
Pakistan is also estimated to have a high proportion of undiagnosed cases.
Prakash says that the vast majority of diabetes cases are “discovered by other health complications” and go untreated.
Improper treatment increases the risk of some infections, especially those caused by fungi.
Africa also has a high proportion of undetected diabetes, almost 60%, but the presence of mucormycosis appears to be very low, only 3%.
Denning points out that the reason behind this figure is that “cases of mucormycosis go undiagnosed because it is not something very easy to identify.”
Several studies have indicated that detection of “black fungus” often fails due to the difficulty of taking tissue samples and the lack of sensitivity of diagnostic tests.
Two widely prescribed steroids, dexamethasone and methylprednisolone, are used in patients with COVID-19 in India to reduce inflammation caused by the body’s immune response.
This is what the black fungus looks like under a microscope.
However, with hospitals and doctors being overwhelmed with an increasing number of cases, there is evidence that these steroids are taken without medical supervision.
The Indian authorities have already discouraged this type of self-medication, which can have very harmful consequences, such as, according to Denning, an increased risk of developing mucormycosis.
A UK trial involving around 2,000 COVID-19 patients has shown that dexamethasone helps reduce mortality in people with moderate or severe infection, but could potentially be harmful to people with mild infection.
This study showed the effectiveness of steroids when used in a hospital setting. However, some Indian states have reportedly distributed dexamethasone to the general public as well as home isolation kits.
“It’s very clear (through studies) that more steroids aren’t necessarily better,” Denning said.
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