Adding to the growing sense of concern over 'black fungus' cases, medicos are now bracing themselves for a new wave of fungal infections afflicting Covid-19 cases, called 'white fungus'.
Although the issue was heightened on Friday by reports of cases in Patna, Bihar, doctors in Bengaluru Urban noted that several Covid-connected 'white fungus' cases have already been found in the city.
However, they added that like mucormycosis, otherwise known as a black fungus because it causes black-looking necrosis of the tissue, that 'white fungus' (also known as candidiasis) is a condition known to the medical field.
“Much before Covid-19, we used to get a few cases of people suffering from a 'white fungus' which creates white splotches, but the infection was localized to the oral cavity or the genital area. We had never seen candidiasis in such disseminated form as we are now,” said Dr Sachin D, Interventional Pulmonology, Manipal Hospitals (Old Airport Road).
He added that this disseminated form included the fungus spreading across organs and skin. “Its effect in the lungs is concerning because it is known to cause pus,” he said.
At the same time, the doctors downplayed the supposed lethality of the fungus compared to mucormycosis. Dr Vishal Rao of HCG Hospital and an advisor to Prime Minister Narendra Modi described reports playing up the dangers of 'white fungus' as false. “We have two to three cases at HCG, all of whom recovered. It is certainly not more dangerous than mucormycosis which requires extensive medical intervention to treat,” he said.
Dr Sachin added: "If caught early, it can be effectively treated."
Four trends
According to Dr Rao, the 'white fungus' has recently been seen across people falling into four trends: heavy steroid use, people with diabetes or drug-induced diabetes, people who required extensive oxygen support while suffering from Covid-19 and those people who have not yet been vaccinated.
Anybody else outside these categories is generally safe, Dr Rao said, clarifying that candidiasis is all around us as part of a normal environment and that people breathe in particles on a regular basis.
Dr Sachin said that Manipal Hospital had noted a few cases among Covid survivors but stressed that these manifestations of the fungus had happened in individuals seriously ill with Covid-19 as they are generally immunocompromised. “This is not just due to the novel coronavirus but also through the use of medication such as tocilizumab, baricitinib and steroids which reduce immunity,” he said.
Research study finds potential mucormycosis source
Despite concerns that steroid use is behind a spate of mucormycosis cases in the state, a new research study has determined that steroid use is only a supplementary cause. According to an as-of-yet confidential report sanctioned by the Institutional Ethics Committee (IEC), the primary cause is the use of tap water in fumigation at district and smaller hospitals.
A source said that the guidelines stipulate that saline water must be used. “However, in many small hospitals and taluk centres, tap water is being used, leading to fungal infection.”