Now, a patient with green fungus flown to Mumbai

In most cases, the fungus and the affected part have to be removed with surgery. Representation pic

On Monday afternoon, a 34-year-old businessman was brought in a special air ambulance from Indore to Mumbai, after being diagnosed with green fungus in his sinus, lungs and blood. He had recovered from month-long Covid-19. Mumbai doctors said he isn't the first case of green fungus (aspergillus infection) in a Covid-19 patient. They are seeing a significant rise in such cases along with other fungal infections like the widely reported mucormycosis - black fungus.

Aspergillosis is the infection caused by Aspergillus, the common mould that lives indoors and outdoors. Dr Ravi Dosi, the pulmonologist who was treating the businessman in Shri Aurobindo Institute of Medical Science in Indore, said he had never seen such an aggressive aspergillus infection. "He had a severe Covid-19 infection two months back. He recovered and got discharged a month back. He returned 10 days back with a nose bleed, high fever and weakness. Diagnostic tests revealed he had aspergillus infection in his sinus, lungs and blood," said Dr Dosi. The patient's family decided to shift him to Mumbai's PD Hinduja Hospital where he is presently admitted in the ICU.

Dr Vasant Nagvekar, an infectious diseases expert at Global and Lilavati hospitals, and also a member of Maharashtra's COVID task force, had recently treated and discharged two Covid-19 patients who had both aspergillosis and mucormycosis.

‘Some have both infections'

"We are seeing rising cases of both green fungus, mucormycosis, and pneumocystis pneumonia (PCP) - another life-threatening fungal pneumonia, and cytomegalovirus infections with Covid-19. In some cases, we are seeing a combined infection," he said. He recently discharged a 28-year-old man from Jalgaon who had both mucormycosis and aspergillus infection. "The 28-year-old man had numbness of the face, orbital pain, tooth ache, etc. and we found him positive for both the fungi. He underwent surgery to remove the infections," added Dr Nagvekar.

He said he has so far treated five Covid-19 patients with aspergillus. Of these, three also had mucormycosis. Dr Nagvekar said there is a significant rise in such fungal infections in Covid-19 patients in the second wave and said the virus itself is immunosuppressive. Dr Nagvekar said unlike mucormycosis, which affects the sinus first, aspergillus is seen first in the lungs.

‘Don't over prescribe meds'

Agreeing with Dr Nagvekar, Dr Om Shrivastav, infectious diseases expert and member of the state task force, said they are seeing a rise in various fungal and bacterial co-infections in Covid-19 patients. "Aspergillus mostly affects the sinuses, head and neck and lungs. Candida affects any part of the body. We are already seeing mucormycosis. And there are other variants like candida auris etc. These infections carry mortality with Covid-19. Fungal infections will be diverse and they won't always be mild with classical features, because Covid-19 itself has a number of presentations that will be misleading. It may not always be the Covid-19 infection alone but a fungal, bacterial and other inflammatory infection with it," he said. Dr Shrivastav said as a clinician, one has to be aware of these infections and treat them appropriately. "The clinician should also ensure s/he is not adding to the situation by over prescribing medicines and provoking these infections," he added.

Dr Lancelot Pinto, pulmonary medicine specialist, PD Hinduja Hospital said the aspergillus infection is seen in swine flu cases too. "Viral infections somewhere lower your immunity and that predisposes you to secondary infections like fungal and bacterial infections in the recovery phase," he said.

Dr Pinto added that use of steroids, uncontrolled sugar levels are other factors leading to these co-infections. "Another hypothesis is that Covid-19 itself increases sugar levels and we are seeing these infections," he added.

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