Curious case of ‘black fungus’ is on the rise in India


A puzzling epidemic of black fungus in India is spiraling out of control, with tens of thousands of COVID-19 survivors now battling the infection which can lead to blindness and death.

The cases of mucormycosis in India have now topped 31,000 and more than 2,000 deaths due to the infection – a 150% increase over the previous three weeks.

Past medical reviews have estimated that the fungal infection—mucormycosis—has an overall fatality rate of around 50 percent. However, mortality rates vary by patients’ underlying condition and what part of the body the mucormycetes fungi invade. Infection can take hold in the gastrointestinal tract, skin breaks, lungs, and blood.

In India, the fungi appear to be mainly taking root in the nose and sinuses, where they can spread to facial bones, eyes, and even the brain. Once an infection is established, it can quickly become aggressive and lead to tissue death. If it spreads to the eye, many patients end up permanently losing vision and, in some cases, need to have their eye entirely removed to keep the infection from spreading.

The government in India has not released official numbers, according to The New York Times. But last month, Prime Minister Narendra Modi called black fungus a “new challenge” in the COVID-19 outbreak.

While it’s unclear what exactly has caused the surge in mucormycosis cases among COVID-19 survivors, doctors have theorized that it is connected to oxygen shortages during India’s most recent surge, The Times reports.

Medical experts hypothesize that the current surge of mucormycosis in India is down to a confluence of factors related to the COVID-19 wave. Many of the cases are occurring in people who are recovering or have recently recovered from COVID-19.

The combination of poor hygiene amid the health crisis, the country’s large number of people with diabetes—particularly uncontrolled diabetes—and an over-reliance on glucocorticoid steroids appear to be playing a role in the fungal epidemic. Steroid use can help treat COVID-19, but it can also tamp down immune responses and make people vulnerable to opportunistic infections, such as mucormycosis.

To help patients breathe when bottled oxygen wasn’t available, doctors resorted to steroid injections, which may have weakened patients’ immune systems and made them more vulnerable to fungal spores in the air.

Patients with diabetes are also already more susceptible to black fungus, and India is one of the countries with the highest prevalence of diabetes, according to the International Diabetes Foundation.

Exacerbating the black fungus outbreak is the fact that there’s a shortage of a key anti-fungal medicine – amphotericin-B – to treat it.