Don't panic by colour of fungus, look for causes, risks: Experts advise as mucormycosis cases rise

Amid rising mucormycosis cases among Covid patients and those who have recovered from it, epidemiologists Tuesday advised people to not get panicked by the colour of the fungus causing it and underlined the importance of analysing the kind of infection, its causes and associated risk-factors.

Health Minister Harsh Vardhan had said on Monday that 18 states have reported 5,424 cases of mucormycosis, a life-threatening infection, prevalent among COVID-19 patients and those who recovered from the viral disease.

Besides Black Fungus cases, White and Yellow fungus infections too were reported from different parts of the country recently, which scientists say are also mucormycosis.

Dr Samiran Panda, the Head of Epidemiology and Communicable Diseases at the Indian Council of Medical Research (ICMR), said the use of "terms like a black, green or yellow fungus" is making people scared and apprehensive.

Also, black fungus getting synonymous with existing mucormycosis is complicating things, 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 infection so that can occur when there is a 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 city’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 and the fungus would be removed. Had he come to me after one or two days only, 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 Dr Panda said the specimen has to be studied to ensure it indeed was yellow fungus which is seen in reptiles.

Professor 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 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.

He said viral and fungal infections are always around, but most people don't get impacted because of their good immunity or 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 that 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 had 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.