After-effects Of COVID-19 And Deadly Black Fungus
Post COVID-19 and how it is affecting the people of India?
More than one year has passed since the Novel Coronavirus SARS-CoV-2 (COVID-19) intruded our lives. It has changed the way we interact with each other. As a Pulmonologist, I came across many patients who have become COVID negative and on their path of recovery from illness. Most of them are genuinely fearful about a few of the symptoms which happen after COVID infections.
Today I would like to answer a few of the common questions asked by my post-COVID patients.
Do I have chances of sudden death as reported in many patients of COVID-19 infection?
The sudden death in COVID-19 is attributed to Micro Angio/Coagulopathy, the condition in which the blood becomes excessively thick and clogs the blood vessels. Such patients need to be started on blood-thinning drugs for at least three months if they have been found to have blood clots into their vessels in their CT scan.
When will I get my taste and smell back?
One of the commonest symptoms of COVID-19 is loss of taste and smell. Researchers have observed that the average time to recover taste and smell was 21.6 days. Almost 95 per cent of patients regained their sense of smell within six months.
What is 'Long COVID Syndrome'? Do I, have it?
Many patients may develop 'Long COVID syndrome'. It is a characterized by a range of symptoms that can start after weeks or months of recovering from COVID-19. Long COVID has been reported in anyone who had COVID-19 irrespective of the severity of illness.
Which are the symptoms of Long COVID?
· Tiredness or fatigue
· Difficulty thinking or concentrating (sometimes referred to as 'brain fog')
· Headache
· Dizziness on standing
· Fast-beating or pounding heart (also known as Heart Palpitations)
· Chest pain
· Difficulty breathing or shortness of breath
· Cough
· Joint or muscle pain
· Depression or anxiety
· Fever
· Symptoms that get worse after physical or mental activities
How to treat Long COVID?
Most of these are self-limited symptoms and usually subsides with supportive care like analgesics and anxiolytics.
What is black fungus disease among post-COVID-19?
The most serious and catastrophic infection observed in post-COVID-19 hospitalized patients is mucormycosis also known as 'Black fungus'.
Why 'Black Fungus' infection so common in India?
There are few predisposing factors that make Indians more prone to developing black fungus infection after COVID-19. Those are:
Environmental
Mucorales are ubiquitous moulds, abundantly found in the environment on decaying organic matter. As our country has hot – humid, tropical climate, hospital ICU air has heavy mould spore counts. This has been proven via many studies conducted on hospital air sample survey.
Host factors
The most common risk factors associated with black fungus is uncontrolled diabetes mellitus and immunosuppression. Black Fungus occurs mainly in critically ill COVID patients who required intensive care treatment, mechanical ventilation, dialysis, and advanced lung–heart support system.
In addition, the use of corticosteroid treatment and anti-IL-6-(Immunosuppressive treatment) in these highly vulnerable patients along with high fungal spore counts in the environment creates the perfect setting for mould infections.
How common is Mucormycosis?
The infection has Global prevalence of 1.7 cases/1 million population. India contributes to 40 per cent of the global burden of this 'rare mould' infection. India with an estimated 77 million cases leads in the incidence of diabetes mellitus too.
This deadly combination of India’s hot humid climate and high prevalence of diabetes has led to the outbreak of post-COVID Black Fungus.
Which is the clinical manifestation of the Black Fungus disease?
Black fungus has two most important manifestations:
1) it can present with symptoms of nasal stuffiness, headache, and visual disturbances in case of rhino-orbital-cerebral mucor or;
2) Pulmonary Mucormycosis: presents with respiratory symptoms of cough and Haemoptysis.
How to diagnose Black Fungus/Mucormycosis?
A high index of clinical suspicion is needed and the clinician has to have seen a good number of cases for early identification of signs of Mucor. Cultures are not positive and GOLD standard for diagnosis is a biopsy. Needless to say, that biopsies are very difficult in such critically ill patients with coagulopathy and other illnesses.
How to treat Mucormycosis/Black Fungus?
The main treatment includes antifungal agents, surgical debridement, along with the reversal of underlying predisposing factors which led to the infection in the first place. Earlier you do the surgical debridement, better the chances of recovery in mucor mycoses or black fungus.
How to prevent it?
As the treatment of deadly COVID-19 is equally harmful as the virus itself, the wise decision of a treating clinician should be judicial use of steroids and other immunosuppressive drugs for their COVID-19 patients.
About the author
- Dr Asmita A Mehta is Professor and Head, Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Kochi
