Covid-19 fallout: Rare fungal infection raises ugly head

Nashik resident Jagannath Shirole, who contracted Mucormycosis after recovering from COVID-19, was operated upon in a special modular OT with ‘laminar flow’ that makes safe surgeries of COVID-19 patients possible

The father of a doctor on Covid-19 duty contracted the virus in April and had to not only battle the disease, but also a deadly fungal infection to save his vision. The infection, called, mucormycosis, begins in the nasal region and spreads to the face, eye and can reach the brain and has come as a new Covid-19-related complication.

Nashik resident Jagannath Shirole, 65, was moved to SevenHills Hospital (SHH) after a drop in his oxygen level. His daughter, Dr Sanchita Shirole, said, "He was asymptomatic and taking treatment at home. Suddenly on April 26, there was a dip in his oxygen level with fever and coughing and I decided to bring him to SHH where I am posted."

Dr Shirole was surprised when, within a few days, Jagannath developed a severe frontal headache with swelling and loss of sensation in the right cheek. "His other parameters improved but these symptoms worried us. My worst fear came true when a CT scan and MRI confirmed mucormycosis," said Dr Shirole.

Aggressive spread

The infection was spreading aggressively, endangering his vision. Dr Ganesh Manudhane, head of cardiology at SHH, requested Dr Shashikant Mhashal, ENT surgeon from RN Cooper Hospital for an emergency surgery along with Dr Varun Dave at SHH.

Nashik resident Jagannath Shirole

"In the 12 hours between detection and surgery, the fungus spread from his right facial cheekbone to right eye orbit. The fungus invades the facial bones, the eye orbit and can spread to the brain rapidly. Mucormycosis, also known as black fungal infection, has a 70 per cent mortality rate which means 7/10 patients die," said Dr Manudhane.

Arrangements were made to operate while Jagannath was still Covid-19 positive. "In the past four to five weeks, we have seen a sudden rise in mucormycosis cases in Covid-19 patients. The disease is progressing fast and needs early intervention with anti-fungal treatment or surgical debridement," said Dr Balkrishna Adsul, dean, SHH. While the infection's symptoms appear two to three days after recovery, in Jagannath's case, they appeared while he was still positive.

Jagannath will need another two weeks of hospitalisation. Many doctors believe the infection is a fallout of steroids used to treat Covid-19. Before the pandemic, the rare disease was seen mostly in tertiary care centres.

Upcoming health problem

Dr Mhashal, who has operated on 10-12 patients for mucormycosis and seen more than 30 cases in the past month, said it is an upcoming health problem. "We hardly saw this complication in the first wave. It is a new, unforseen challenge in the second wave. Presently, I have two patients admitted in RN Cooper Hospital, one of them has lost his vision and another is on the verge. We need to pick the infection early and treat it like we did in Jagannath's case," said Dr Mhashal.

KEM Hospital has 12-13 patients of mucormycosis. Doctors say these patients need long-term hospitalisation too.

Need to spread awareness

"We need to spread awareness on early intervention, good blood sugar control. Some warning signs are blackish nasal discharge, facial pain, headaches and pain around the eyes," said Dr Maharudra Kumbhar, officer on special duty at SHH.

Dr Kumbhar added, "At SHH, we have made a modular operation theatre with laminar flow which creates a negative pressure environment, making safe surgery of COVID-19 patients possible."

70 per cent
Mortality rate in mucormycosis patients