Srinagar:- As Jammu and Kashmir records first death of a patient with Mucormycosis commonly known as ‘Black Fungus’ at Government Medical College Jammu, the health experts in Kashmir have sounded an alert and asked the people to remain on guard and follow the advisories.
Principal GMC Jammu, Dr Shashi Sudan said that the person was under observation for the last two days and subsequently succumbed this afternoon at the health facility. “The patient had recently recovered from Covid-19 and was now suffering from uncontrolled diabetes”, she said. “The patient had Mucormycosis apparently due to long term use of steroid drugs.”
The “Covid-triggered” black fungus infection is rising in India. So far, over 7,000 people have been infected with the disease and over 200 have lost their lives.
The doctors in Kashmir maintain frequent use of steroids during Covid treatment, impure water for humidifiers during the oxygen therapy are the major cause behind this infection.
They also added that patients who are diabetic or Covid positive and the people with weak immune systems have an increased chance of contracting the infection.
Dr. Shafqat-ul-Islam, senior consultant ENT at Jawahar Lal Nehru Memorial Hospital (JLNM) told Kashmir Observer that one of the main reason for the spreading of the fungus during pandemic is the industrial oxygen, which has been directed for medical use, could be one of the main sources of contamination.
“The industrial oxygen diverted for covid patients is suspected to be the source of the fungus in areas of oxygen shortage like Delhi and elsewhere but it can happen in Kashmir as well, besides the routine reasons of decreased immune status due to diabetes and the use of steroids,” he says
“One of the main reason for the spreading of the fungus during pandemic is the industrial oxygen, which has been directed for medical use. The industrial oxygen diverted for covid patients is suspected to be the source of the fungus in areas of oxygen shortage like Delhi and elsewhere but it can happen in Kashmir as well, besides the routine reasons of decreased immune status due to diabetes and the use of steroids,” said Dr. Shafqat-ul-Islam, senior consultant ENT.
He says the misuse of steroids can also be one of the reasons but at the same time argues that it is being given throughout the world, however no country witnessed the fungus.
“My point is the diabetic and weak immune system patients are throughout the world and people used steroid frequently so why wasn’t the disease reported anywhere,” he says adding that it is because of the industrial oxygen that use impure water to make oxygen, that is why more and more cases are reported in India.
However, the leading ENT specialists maintain that Black fungus disease was there, even before the pandemic and was mostly found in Diabetic patients.
Dr. Shafqat warned that if the disease is not detected at the early stage, the fungus reaches to the brain resulting in the death of the patient.
He noted that a patient has to maintain his blood sugar and has to be “vary cautious” about it.
According to Influenza expert Dr. Nisar ul Hassan, also president of the Doctors Association Kashmir (DAK) one of the factors through which COVID-19 positive can contract this disease is the humidifiers, streamers which they use.
“If the water of these medical equipment is unchanged frequently, it will become a breeding ground for the fungus,” Dr. Nisar said.
He noted the fungus is COVID-19 patients have higher chances of contracting the fungus because these medical equipment including the wall oxygen aren’t cleaned for weeks and months.
“The recommendation is that you have to use sterilised water for the equipment and change it frequently and yes this is the big factor of the disease,” he added.
According to doctors, black fungus is a rare fungal disease and is considered more deadly with a mortality rate of 50 per cent.
According to reports, in many states of India, Doctors removed people’s eyes and jaw bones, trying to stop the spread before it reached their brains but leaving the patient permanently disfigured.
Dr. Nisar told Kashmir Observer he has seen just five fungus cases in his 30 years of medical profession till this disease was declared on May 20.
He said the fungus is present everywhere be it soil, plants, air, manure, construction or dusty areas, hospitals (if kept unclean) and decaying fruits and vegetables.
Dr. Nisar said, patients with immunocompromised (having an impaired immune system) are usually found if somebody has a chronic disease like cancer, kidney failure , diabetes, liver disease etc.
“So because of the these chronic disease, the fungus becomes invasive or deadly for those patients usually,” he said adding that “It is also seen now in the covid-19 recover patients even after days of recovering,”
The symptoms
The Doctors advised that it is important for the people to understand the disease and know about the symptom earlier.
The symptoms, according to doctors for the black fungus are, headache ( for the COVID-19 recovered patients) swollen eyes, pain or numbness over half the face, nasal blockage and a blackish nasal discharge, black crusts in the nose, black scars under the eyes and nose and vision loss are some early signs of mucormycosis.
Dr. Nisar said, if it goes into the brain, the patient can go into coma and if it goes into lungs—the patient can have similar symptoms that of covid-19.
The patient needs to consult the ENT specialist immediately, if these symptoms are found and the early diagnosis can save him, the doctor noted.
He said to prevent this life-threatening disease in COVID patients, doctors should use steroids judiciously and ensure there is no misuse of steroids.
Cases reported last year
According to a report, some cases of Mucormycosis were found in Kashmir division in the first wave of pandemic, among them three patients died.
Dr. Rouf Ahmad Professor and head ENT at SMHS Hospital, who operated on a few patients with Mucormycosis confirmed to Kashmir Observer that they had witnessed some cases of black fungus last year.
“The disease has different stages and accordingly the treatment is done. In any case you have to do the endoscopic surgery,” Dr. Rouf said.
Follow Health advisory
On 19 May, the Directorate of Health Services Kashmir issued an advisory for the prevention of Black Fungus after such cases were reported in Covid-19 patients in many parts of India.
“Better control of the sugar levels during COVID with or without steroids. Judicious use of steroids observing correct timing, correct dose and correct duration,” the advisory said.
It said there should be judicious use of antibiotics or antifungal drugs.
“To use clean, sterile water for humidifiers during the oxygen therapy, use distilled or sterile water, never use unboiled tap water or mineral water,” it said.
“Fill up to 10 mm below the maximum fill line, check the water level twice daily and top it up as necessary. Ensure that once a week all the components of the humidifier should be soaked in a mild antiseptic solution for 30 minutes, rinsed with clean water and dried in air,” the advisory said.
Furthermore, Chief Medical officers are directed to ensure that the sale of steroids by retail medical shop owners is regulated and dispensed only under a valid medical prescription.
Dr Mir Mushtaq, spokesperson to the Health Department at Directorate of Health Services Kashmir urged people to follow the health advisories issued by the department.
“If people find any symptoms related to this disease, they need to report to the hospital immediately and avoid self medication including use of steroids,” he said.
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