"He has undergone three surgeries, lost vision from one eye permanently and it is going to be difficult for him to talk or eat due to the removal of the palate. It's all so devastating", Makarand told a news agency about his brother's battle for survival from what has become a dreadful outbreak in India - Mucormycosis or Black Fungus infection. 

Makarand's brother 35-year-old Milind Deshmukh was battling double threats -Novel Coronavirus and Black Fungus Infection, which is equally dangerous like the pandemic. Deshmukh is a mechanical engineer from Thane and he was diagnosed with a fungal infection while battling the pandemic. Milind's family had immensely left devastated after learning about the fungal infection and though it's not new for India, the recent surge in cases of Mucormycosis has put the country in a fret. 

In a month, the fast-spreading fungus had eaten a large portion of Milind's facial tissue, including his right eye and the palate, which has led his brother Makarand to say "It's all so devastating." India is grimly steering through the horrendous second wave of the pandemic and while the country is witnessing a dearth of beds in hospitals and of spaces in crematoriums, the health experts are warning that India is bracing up the outbreak of Mucormycosis as the cases are rising in an unprecedented scale. 

The Black Fungus infection cases are rising in the states that are witnessing the rampant spread of COVID-19 including Maharashtra, Delhi, and Gujarat. Doctors in India have been recording a big spurt in cases of fungal infection, which is aggressive and hard to treat. While mucormycosis cases have been seen in the country before, the current increase in infections is among people infected with COVID-19 and those who have recovered from the pandemic. Let's take a look at what is mucormycosis, its symptoms, and what's the treatment.

What is Mucormycosis?

Mucormycosis is a health complication caused by a fungal infection. People will get exposed to this dangerous infection by coming in contact with the fungal spores in the environment. It is caused by a group of mould called mucormycetes. According to the Center for Disease Control and Prevention (CDC), these fungi live in the environment, particularly in soil and in decaying organic matter, such as rotten wood, compost piles, and leaves. When someone breathes these fungal spores, they are likely to get the fungal infection that commonly affects the sinuses or lungs.

The infection can also develop on the skin after the fungus enters the skin through a cut, scrape, burn, and other types of skin trauma. Health experts say that mucormycosis catches the people who are already battling illnesses or taking medications that would decline the body's immune power to fight the foreign pathogens. The experts attribute the unprecedented surge of fungal infection to the exponential rise of the COVID-19 cases. 

The disease is being detected among patients who are recovering and recovered from the COVID-19 viral infection. The people suffering from diabetes, who once got affected by the pandemic, must be more careful towards the fungal infection. According to an advisory by the Indian Council of Medical Research, a person is susceptible to Mucormycosis under the following conditions - Uncontrolled diabetes, prolonged ICU/hospital stay, weakening of immune system due to use of steroids, Comorbidities/post organ transplant/cancer, and Voriconazole therapy (used to treat serious fungal infections). 

According to reports, the patients with COVID-19 would develop a weak immunity and a large number of them are put on steroids in order to control a hyperimmune response, which leads them to be vulnerable to fungal infections like mucormycosis. The majority of mucormycosis infections have been recorded in COVID-19 patients with diabetes or those with underlying and undetected high blood sugar. The experts say that India's poor air quality in cities such as Mumbai makes the fungi live longer. 

How Mucormycosis is surging with the help of COVID-19? 

In normal conditions, our body's immune system can successfully combat and kills such fungal infections. However, when one contracts the COVID-19 pandemic, the immune system would be collapsed in case of existing diseases. Moreover, the treatment of COVID-19 patients involves the intake of drugs like dexamethasone, which suppresses the response of the immune system in countering such infections. In such cases, the COVID-19 patients can contract the fungal infection easily if they breathe the rotten spores of fungi.

Along with that, the COVID-19 patients who are undergoing oxygen therapy in ICU, where a humidifier is used, are prone to fungal infection because of exposure to moisture. People who don't have diabetes or any other comorbidities can beat the infection but extensive treatment would be required for people with comorbidities as this fungal infection can be fatal if not treated timely.

The experts say that Mucormycosis begins to spread as the skin infection in the air pockets located behind our forehead, nose, cheekbones, and in between the eyes and teeth. It then spreads to the eyes, lungs, and can even spread to the brain. It leads to blackening or discolouration over the nose, double or blurred vision, breathing difficulties, chest pain, and coughing of blood. 

The western state of Maharashtra has recorded about 2,000 cases and eight deaths due to Mucormycosis as of Thursday and the state's health minister Rajesh Tope has announced the installation of special wards in hospitals to treat the fungal disease. The doctors in New Delhi have been reporting that the city is witnessing a surge in the cases of fungal infection. Gujarat has also been witnessing the rise in cases and state officials have also placed orders for the anti-fungal drug called Amphotericin-B, which is used in treating fungal infection. 

The Ahmedabad Civil Hospital has seen the admission of 19 Mucormycosis patients in the last week as the country prepares to battle another form of health menace amid a war with the novel coronavirus. As the cases are steadily increasing, the experts are suggesting that the COVID-19 recovered patients must maintain the required blood sugar level. Though it is not transmissive like Covid, Mucormycosis is equally dangerous like the pandemic but can be slain with proper treatment and measures. 

What's the treatment for the fungal infection?

While the infection may start as a skin infection, it can spread to other parts of the body. Normally, the treatment involves surgically removing all dead and infected tissue. In some patients, this may result in loss of the upper jaw or sometimes even the eye. The Indian Council of Medical Research (ICMR) has suggested that controlling diabetes is one of the foremost prevention methods to cure fungal infection and the COVID-19 patients, who are diabetic, are advised to take full care. Experts say that affected patients must follow the doctor's advice and prescription and patients should avoid self-medication and over-dosage of steroids. 

The infection could be cured with four to six weeks of intravenous anti-fungal therapy. The Covid-19 affected and recovered patients, with diabetes, must follow the following measures to stay away from Mucormycosis - control hyperglycemia (high blood sugar), monitor blood glucose level after getting recovered from Covid-19, and in diabetics. They must use steroids judiciously, use clear and sterile water for humidifiers during oxygen therapy and use proper antibiotics. As the Central and state governments are preparing for the battle of curbing the spread of fungal infection, they are pushed to encounter a fresh health crisis as the surge of cases of fungal infection has grimly become a cause of worry.