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Wednesday, June 23, 2021

Mucormycosis found more in men, people with diabetes: study

The study titled ‘Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India’, analysed 101 cases of Covid-19 patients contracting mucormycosis, a rare but serious fungal infection.

Written by Tabassum Barnagarwala | Mumbai |
Updated: May 22, 2021 1:25:19 pm
Unholy trinity: Diabetes, rampant use of steroids amid Covid appear to increase mucormycosis: StudyA doctor examines an nasal endoscopy X-ray to detect black fungus in a Covid patient in a hospital in Jabalpur. (PTI Photo/Representational)

Men are more susceptible to getting infected by mucormycosis – known colloquially as “black fungus” – according to a soon-to-be published study conducted by four Indian doctors.

The study titled ‘Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India’, analysed 101 cases of Covid-19 patients contracting mucormycosis, a rare but serious fungal infection. It found that 79 of those infected were men. Diabetes mellitus was found as the single most important risk factor with 83 of the 101 suffering from it.

The study is slated to be published in journal Elsevier. Dr Awadesh Kumar Singh and Dr Ritu Singh from GD Hospital and Diabetes Institute in Kolkata, Dr Shashank Joshi from Lilavati hospital in Mumbai and Dr Anoop Misra from National Diabetes, Obesity and Cholesterol Foundation in New Delhi together studied 101 patients, including 82 from India, 9 from the US and three from Iran.

Covid-19 associated mucormycosis has become a notifiable disease with maximum deaths (90) being reported from Maharashtra so far.

The study recorded 31 of the 101 people dying due to the fungal infection. The data showed that 60 of the 101 individuals who developed mucormycosis had active Covid-19 infection and 41 had recovered. Also, while 83 of the 101 people had diabetes, three had cancer.

Dr Shashank Joshi, also an endocrinologist, said they studied what treatment mucormycosis patients took for Covid-19. A total of 76 patients had a history of corticosteroid used as an immunosuppressant, 21 were administered remdesivir and four tocilizumab.

In one case, a 60-year-old man from Mumbai with diabetes was administered both steroid and tocilizumab. He succumbed to the fungal infection. But a 38-year-old man in Mumbai with no diabetes survived. Association of death and severity in diabetic patients with Covid-19 was found higher in the study.

Mucormycosis can affect nose, sinuses, orbit, central nervous system, lung, gastrointestinal tract, skin, jaw bones, joints, heart and kidney. The study showed that in most cases, over 89, the fungal growth was found in nose and sinus. This could be because Covid-19 affects respiratory system the most.

The study also found that fungus Mucorales spores are spreading in people with Covid-19 in an ideal environment of low oxygen (hypoxia), high glucose, acidic medium and decreased white blood cells activity due to the use of immunosuppressants. It said that while global prevalence of this fungal infection is 0.005 to 1.7 per million population, in India, it is 80 times higher due to a higher diabetic population.

Joshi said the study has advised “judicious evidence-based use of corticosteroids in patients” and control of their blood sugar levels.

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