Gujarat: Over 100 black fungus cases, government announces separate wards for patients

With an alarming increase in mucormycosis cases, a fungal infection as a post-coronavirus complication, the state government in a core-committee meeting under Chief Minister Vijay Rupani on Saturday announced that all government civil hospitals, especially in Ahmedabad, Vadodara, Surat, Rajkot, Bhavnagar, and Jamnagar, where high incidence of the infection has been noted, will set up separate wards for treatment of such patients.

More than 100 cases of mucormycosis, also known as black fungus, have been notified across state government hospitals and Gujarat Medical Education Research Society (GMERS) hospitals, the government said. Currently, Ahmedabad’s Zydus Hospital has around 40 such patients while Vadodara’s SSG hospital is treating 35 patients.

In Ahmedabad’s Civil Hospital at Asarwa, 19 patients are undergoing treatment at the two wards, with 60 beds each, which have been created for treating mucormycosis patients.

Earlier, on April 22, at a press conference organised by the state’s task force of medical experts in Gandhinagar, Dr VN Shah, the director at Zydus Hospital in Ahmedabad, had said within a span of two days the hospital had seen nearly 10 patients of mucormycosis and, overall, the private hospital was seeing an alarmingly high number of mucormycosis cases.

However, as the infection is not categorised as a communicable disease, the state health department does not maintain a public record of the same, unless individually notified by hospitals.

On Saturday, the state government announced that it has placed an order for 5,000 injections of the antifungal drug, Amphotericin-B, at a cost of Rs 3.12 crore, used in the treatment of the fungal infection.

Leader of Opposition and Congress MLA Paresh Dhanani on Saturday also wrote to the chief minister requesting that sufficient stock of the Amphotericin-B injections be replenished at hospitals as shortages are being reported at several places.

Besides the antifungal injection, treatment can include surgical intervention and control over diabetes, with the latter especially aimed at avoiding a relapse of the infection.

As per the state health department, symptoms depend on where the fungus was growing in the body. If the growth is on the sinus and brain region, symptoms can include one-sided facial swelling, headache, nasal or sinus congestion, fever, and black lesions on the nasal bridge or upper inside of the mouth that can quickly become more severe. It may also lead to eye pain and ultimately result in loss of vision if not treated immediately. If in the lung, symptoms may include fever, cough, chest pain and shortness of breath.

Skin mucormycosis can look like blisters or ulcers and the infected area may turn black. Gastrointestinal mucormycosis may be indicated by abdominal pain, vomiting and gastrointestinal bleeding, doctors said.

Experts, based on the patient profile of mucormycosis, have repeatedly warned against excessive use of steroids, especially in those with uncontrolled diabetes. The infection which deteriorates rapidly, often utilises a compromised immune system, thus putting at greater risk those such as cancer patients, organ transplant patients, long-term steroid users, or those inhaling moist oxygen, malnourished or underdeveloped infants, and those who have had stem cell or bone marrow transplant.

Dental consultant at Zydus Hospital, Dr Prachi Desai, meanwhile, said currently there have been cases where patients without a medical history of diabetes or long-term steroid usage were being detected with mucormycosis.

“It is suspected that Remdesivir could be causing an imbalance in sugar levels, which may then lead to this. Recently, I had to operate and partially remove the lower jaw of a 60-year-old patient who was exhibiting all symptoms of mucormycosis but his biopsy and KOH microscopic examination — the only two tests to clinically detect mucormycosis — came negative. We operated going by the symptoms. When this jaw section that was removed was sent for a biopsy, the report came as positive for mucormycosis. We will be reconstructing the lower jaw with fibula (calf bone) and are hopeful that since it is the lower jaw, there won’t be any further spread.”

A hospital source said, liposomal Amphotericin-B, which is to be administered in mucormycosis patients with chronic kidney disease, was currently seeing a shortage in the drug market.

The medical superintendent of Vadodara’s SSG, Dr Ranjan Aiyer, said, “Until now, the disease has been particularly prevalent in patients with uncontrolled diabetes. Patients are now given steroids during Covid-19 treatment, which is a life-saving drug. But some essential drugs also indirectly affect the body’s immunity. Mucormycosis spreads from the nose and the surrounding area to other places through the eye. So far, we have performed three orbital exenteration (extraction of the eyeball) on patients, whose eyes were severely affected due to the fungal infection.”