Mumbai: With the rise in cases of mucormycosis or black fungus in Covid patients, there has been a corresponding rise in demand for the injection Amphotericin B, by almost 15-20 per cent, amid the second wave of coronavirus lashing the state. Last week, The Free Press Journal had reported that the city hospital had 151 patients suffering from this fungal condition, with many of them suffering loss of vision and facial disfigurement.
What is Black Fungus?
In the pre-Covid era, mucormycosis was known to be a rare serious fungal infection seen in immune-compromised patients. It is caused by a group of moulds known as mucormycetes, present naturally in the environment. Mucormycosis is said to invade the facial bones, the eye orbit and can spread to the brain rapidly. It has a 70 per cent mortality rate – meaning seven out of 10 who contract the infection are likely to die.
Dr Shashank Joshi, member of Maharashtra’s Covid TaskForce, who is a consulting endocrinologist at Mumbai’s Lilavati Hospital, said mucormycosis needs to be diagnosed and detected on time. “The task force is mindful of the rise in these anti-fungal cases in Covid patients. The key is prevention and early diagnosis. While treating a Covid patient, the right dose of steroids needs to be given at the right time, ensuring it is tapered off,” said Dr Joshi.
Doctors said given the large number of undiagnosed cases of diabetes and other chronic illnesses in rural and tribal areas where Covid is rapidly spreading, many people in these regions could be suffering from this deadly disease. They have been seeing more than 10 patients daily from outside Mumbai who are afflicted with this condition and in immediate need these injections.
A senior doctor from a civic-run hospital said that earlier, they would get calls or messages for arranging Remdesivir or oxygen beds for the patients but now, there are daily requests for anti-fungal injections.
“We are helpless now, seeing patients suffering from mucormycosis or black fungus infection but are unable to arrange injections or medication for them, as these are not available at any chemist’s or hospitals. We are requesting the state government to make these injections available in the market, so as to curb the deaths due to mucormycosis,” he said.
According to the data provided by the civic health department, 15 people have succumbed to the mucormycosis in the last three months, 11 of whom had died in April when Covid cases were on the rise.
Prasad Danave, president, Retail and Dispensing Chemists Association, said earlier these were sold to the hospitals directly for treating cancer patients but now, there is a sudden rise in the demand for Amphotericin B for treating patients with mucormycosis. Accordingly, they have asked seven pharma companies to meet the present demand, for which the latter are working continuously.
“Individuals will not be able to procure this injection from chemists, as it is widely distributed through government channels. To obtain it, patients need to apply at the collector’s office of their respective districts. Meanwhile, the government is analysing the situation and in coordination with the Food and Drug Administration (FDA), they are distributing it to the hospitals,” he said.
FDA Commissioner Parimal Singh said currently they had around 16,500 vials of Amphotericin B for treating mucormycosis patients. However, these will be distributed by the respective health departments of the districts, depending on the demand. “We have requested the Central government to provide more vials, as cases are increasing. Moreover, the civic body is also procuring these injections through expressions of interest, following which there will be no shortage,” he said.
The Indian Council of Medical Research (ICMR), the apex body in India for the formulation, coordination and promotion of biomedical research, has established guidelines on the deadly fungal infection increasingly arising in Covid-19 patients. The ICMR guidelines talk about the screening, diagnosis and management of mucormycosis. The state too is forming a multidisciplinary team consisting of an internal medicine expert, an ENT surgeon, an infectious diseases expert and an endocrinologist to set out guidelines and strategies on mucormycosis management and bringing down the numbers.
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