‘Several lethal fungal infections haunting Covid-19 patients’

KARACHI: In addition to lethal Mucormycosis or ‘Black Fungus’ cases, some other ‘opportunistic fungal infections’, including Covid-19-Associated Pulmonary Aspergillosis (CAPA), have been found among serious Covid-19 patients and those who recovered from the disease in Pakistan, officials and experts said on Wednesday.

“Invasive fungal infections (including Mucormycosis aka Black Fungus, CAPA and others) were recognized early on and all those who treat it know about it,” Special Assistant to Prime Minister (SAPM) on Health Dr. Faisal Sultan told The News when asked if cases of Black Fungus and other fungal infections were being reported in the country. He, however, made it clear that as “it is not a reportable entity, no central data is available.” Data of cases can be acquired from the Aga Khan University (AKU), Shaukat Khanum Hospital and other such organizations that keep good data, he added.

To a query regarding inappropriate and unjustified use of steroids and antibiotics, Dr. Faisal Sultan said: “Steroids when used inappropriately (eg on persons not on oxygen) are harmful. Similarly, antibiotics are harmful unless a clear indication or suspicion of a bacterial infection is present.”

On the other hand, infectious diseases experts from the Aga Khan University Hospital (AKUH) confirmed that not only the Mucormycosis but also cases of other opportunistic fungal infections were being seen by them and other centers, saying they were seeing more common cases of Associated Pulmonary Aspergillosis and fungal infection among Covid-19 patients since last year.

“In fact, AKUH was among the first few centers of the world which reported Covid-19 Associated Pulmonary Aspergillosis (CAPA) cases. It is another type of fungal infection, which is comparatively less lethal as various treatment options are available against it but it is more common in both Covid-19 and non-Covid patients,” said Dr. Nosheen Nasir, an Assistant Professor of Infectious Diseases at AKUH.

Government officials confirmed to The News that at least four patients who had contracted Mucormycosis or ‘Black Fungus’ had died during treatment at a private hospital in Karachi, adding that even the CAPA caused aspergillus had claimed lives at their center and other health institutions, adding that cases of yeast infections including Candidiasis were being seen among people who had recovered from Covid-19.

Fungal infections only affect those who are immunocompromised or have weak immunity, Dr. Nosheen Nasir from AKUH said, adding that in addition to Covid-19 patients, who are given steroids and are diabetic, injudicious use of antibiotics and unsupervised administration of steroids were some of the main reasons that weakens the immunity and people become an easy target for fungal infections.

“First of all, everybody who is tested positive for Covid-19 starts taking antibiotics, especially Azithromycin, which is very important drug against several serious infections including XDR Typhoid. Kindly don’t take antibiotics on your own. Secondly, national guidelines on steroids use should be followed as their unjust use can lead to weakening of immune system and poor control, which can cause fungal infections”, she added.

Another infectious diseases specialist associated with AKUH Dr. Faisal Mehmood, while explaining the Black Fungus and other invasive infections ,said the spores or seeds of this fungus (called mucor) are floating in the air everywhere. “In fact, at this moment, as you breathe, you are likely breathing into the spores of this deadly fungus. However, the body’s immunity can very easily take care of this in normal circumstances”.

However, if for some reason a person’s immunity drops and at the same time there are conditions in the body that help the fungus grow, these spores can take root and cause an infection, he added.

“This is why we often see this in the sinuses (most common) or the lungs as this is where it enters from. But uncommonly we have seen this in wounds as well if the fungus enters from there,” Dr. Faisal Mehmood maintained.

He further said that some of the medications used in Thalassemia to reduce the iron in the body also increase the risk as ‘this fungus prefers iron’ and the medication renders iron in a form which the fungus could easily use. “Black Fungus or others are not hospital acquired infections,” he clarified.