Immunocompromised patients are more vulnerable to a life-threatening infection

Unlike zika, some viruses and fungi just don’t grab headlines. They come stealthily and wipe out people. Take, for instance, mucormycosis, caused by a common fungus found in the air, soil and dying plants. The infection has claimed many lives in India. But it is still grossly under-diagnosed.

An immunocompromised patient may be particularly susceptible to this infection. “India, which has a huge burden of diabetes, is highly vulnerable to mucormycosis,’’ says Dr George M. Varghese, professor, department of infectious diseases at Christian Medical College, Vellore. The country is home to about 70 million diabetics. “People with uncontrolled diabetes fall prey to the fungal infection as the neutrophil [relating to white blood cell] function in them gets affected,” explains Varghese. Diabetes provides a happy environment for the fungi. High sugar, free iron and acidic pH help the fungal spores of mucor sporulate and grow rapidly.

Among the other vulnerable groups are cancer and HIV patients and those receiving chemotherapy or immunosuppressive drugs. Victims of road accidents may also develop this infection, as the bad wounds get infected by fungi. Not that healthy people don’t catch the infection. Some of the patients diagnosed with kidney mucormycosis did not have any of the risk factors. Experts say that this is a unique clinical condition described from India.immunocompromised

Mucormycosis is a condition of great concern as it is very life-threatening, says Dr Ameet Kishore of Indraprastha Apollo Hospitals, New Delhi. “The mortality rate is very high in mucormycosis. Fifty per cent of patients can die if the infection is not controlled. It is the most aggressive type of fungal sinusitis,” says Kishore. It spreads very rapidly. “The common sites of infection are the nose and the sinuses. From the sinuses, it can go into the eyes and cause blindness. Sometimes it goes to the brain and causes brain complications,” he says.

The incidence of mucormycosis is significantly higher in developing countries like India. Mucorale fungus, which causes the infection, is abundant in our environment. “Inhaled spores of mucor are lodged in our sinuses and lungs. Whenever appropriate environment is available, the spores germinate and produce infections,” says Dr Atul K. Patel, chief consultant and director, infectious diseases clinic, Vedanta Institute of Medical Sciences, Ahmedabad.

Sidhamma, a 54-year-old diabetic who works in a block development office in Tamil Nadu, had facial pain and swelling. She consulted a doctor as she couldn’t open her left eye. Sidhamma had mucormycosis. The symptoms of the infection depend on the site of infection. “Patients with sino-orbital involvement, which is common in diabetics, generally present with facial pain, nasal stuffiness, discharge, orbital pain, visual disturbances, loss of vision, protruding eye ball, facial swelling and fever. Patients with lung diseases have fever, cough, chest pain, blood in sputum and breathlessness,” says Patel.

The standard treatment for mucormycosis is antifungal drugs and surgery. “Patients completing a course of amphotericin B treatment are major survivors,” says Patel. “The liposomal form of amphotericin has the least side effect, but is costly. The oral medicine posaconazole, which is used after the amphotericin treatment, is also costly,’’ says Varghese. Many patients discontinue treatment, unable to bear the cost, which can go up to Rs 12 lakh.

Diagnosed with mucormycosis, Hanumanthappa of Krishnagiri was determined to go ahead with the treatment, though he knew it would cost him a lot of money as his eye that was badly affected had to be removed. His family is, however, happy that his life could be saved.

Is mucormycosis a new infection? “It is not. I saw the first case of mucormycosis 15 years ago,” says Kishore. “But it was very rare at that time. People would die due to lack of treatment as the infection was not being recognised then.” Kishore says mucormycosis is very much prevalent in India. “We see it on a regular basis. Perhaps because there are more number of immune compromised patients now. In the past there were not many organ transplants done,” he says. However, there are no official statistics on the prevalence of the disease.

Fungal Infection Study Forum, a group of infectious diseases doctors, intensive care specialists and microbiologists, is now conducting an epidemiological study on mucormycosis in 17 centres across India.

“The study looks at the risk factors, site involved with mucormycosis, and response to treatment,” says Patel, who is the co-chairman of the forum. Patel hopes the study will help decode the infection to a great extent.

Names of patients have been changed to protect privacy.