NEW DELHI—A 52-year-old diabetic was recovering from Covid-19 at his home in the southern Indian city of Hyderabad in late April when his blood sugar levels shot up to four times the normal level. The left side of Yaseen Ahmed’s face, including his eye, nose and gums started to swell, and there was some discharge.
Mr. Ahmed was diagnosed with a rare but often deadly fungal infection afflicting thousands recovering from Covid-19 in India, where doctors are running out of an antifungal drug used to treat it.
The infection, mucormycosis, also known as “black fungus” because it turns body tissue black, is mostly affecting people with diabetes. With 77 million diabetics out of an adult population of more than 850 million, India has the second highest number of diabetics in the world, behind China.
“We didn’t know anything about mucormycosis,” said Mr. Ahmed’s son, Wasay Ahmed.
The New Delhi city government said Thursday it had set up mucormycosis treatment centers at three government hospitals in the capital. Many states have reported more than 500 cases each, authorities said on May 15. The health minister for the western state of Maharashtra, home to India’s financial hub Mumbai, said on Thursday that 1,500 people in the state were infected. Some patients have died. Others have lost their eyesight.
The condition is usually rare, infecting for example about five to 10 people a year in the U.K., a country of 67 million, said David Denning, professor of infectious diseases in global health at the University of Manchester in England and an expert in fungal infections.
Many parts of India have been reporting shortages of amphotericin, an antifungal drug used to treat mucormycosis. Although the drug is manufactured in India, the sudden increase in cases has stretched supply. On Friday, the government said pharmaceutical companies were increasing production to meet the demand and authorities were seeking to import more than 350,000 vials this month.
In Kota, a town in the northwestern state of Rajasthan, Toshika Saxena said she is desperately trying to find amphotericin for her mother, Vimlesh Saxena, 50, who developed swelling in the left eye one week ago after recovering from Covid-19. She needs surgery to remove infected cells but doctors won’t do it unless she can obtain the drug, Toshika Saxena said. The longer the surgery is delayed, the more the fungus will spread, potentially reaching the brain, she said.
The spread of mucormycosis is being turbocharged by sometimes excessive doses of steroids such as dexamethasone used to treat Covid-19, doctors said. Diabetes often reduces the effectiveness of infection-fighting white blood cells, allowing a fungus that is common in the air to take hold.
“There appears to be a failure of the immune system to tackle the fungus,’’ Prof. Denning said.
Excessive steroid use can also push prediabetics into full-fledged diabetes.
Dexamethasone can be used to treat patients who are struggling to breathe, doctors say, but no more than 6 milligrams a day should be administered for seven to 10 days. Many people in India, lacking access to doctors, have been self-medicating with the drug, and taking it to prevent the need for oxygen support—though doctors say it has no benefit for people who don’t require oxygen and can be harmful. Some doctors are also administering dexamethasone in quantities significantly beyond the recommended dose when they have limited access to oxygen.
“We are using much higher doses in India” than recommended, said Rajesh Pande, director of critical care at BLK Super Speciality Hospital in Delhi.
Authorities in India, in response to the rise in mucormycosis cases, recently issued guidelines on steroid use in Covid-19 patients and asked people to refrain from using steroids when experiencing mild symptoms in the first week of infection. A moist environment created by oxygen use also allows the fungus to thrive, they said.
Severely ill Covid-19 patients who received immunosuppressants, a lifesaving drug used to prevent the body from attacking itself, are additionally seen as vulnerable to mucormycosis, said Atul Patel, chief consultant for the infectious diseases department at Gujarat’s Sterling Hospital in Ahmedabad.
In Dr. Patel’s hospital, some 30 mucormycosis patients have been admitted in the past two weeks. The western state of Gujarat has among the highest numbers of cases of the illness.
Mucormycosis doesn’t spread from one person to another. People are most commonly infected by inhaling spores, which grow in soil, on plants and in decaying fruits and vegetables. Masks can prevent infection. Black fungus typically infects the nose and the sinuses first, turning the nasal lining black and eventually eating away at tissue. It can cause headaches and difficulty breathing. It can also affect the lungs and brain.
“Those symptoms, we are now making people aware of because it can be treated in the early stages but if untreated, it is quite dangerous,” said Naresh Trehan, a cardiac surgeon and head of the Medanta hospital chain.
In severe cases, mucormycosis can prove deadly or debilitating, including possible paralysis and the need for limb amputation. Early diagnosis, which requires a biopsy, and treatment using drugs such as amphotericin, combined with surgery to remove infected cells, can save 50% of patients, Prof. Denning estimated. But for patients who are left untreated, the fatality rate rises to between 80% and 90%, he said.
The care required to treat mucormycosis is further adding to India’s already overextended health system and the burden on families. A weekslong hospital stay, after families have already shouldered the costs of Covid-19 treatments, can be expensive for patients, whether they seek public or private hospital care, said Ambrish Mithal, chairman and head of endocrinology and diabetes at the Max HealthCare hospital in Delhi.
Earlier this month, Yaseen Ahmed underwent surgery in a southern Indian city. His left cheekbone was removed to stem the spread of the infection. His son, Wasay Ahmed, was then told to find amphotericin to treat his father’s remaining infection. “We are unable to find that injection anywhere in Hyderabad,” he said.
On Friday, Wasay Ahmed applied to the government for the 60 vials of the drug that his father’s doctor has advised. The government has said they would provide five. “I don’t know what further I have to do,” he said.
Write to Suryatapa Bhattacharya at Suryatapa.Bhattacharya@wsj.com and Shefali Anand at email@example.com
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