Mumbai: Bhaidas Mali, 35, a police sub-inspector with the Maharashtra police is currently waiting to undergo plastic surgery to reconstruct his palate at Global Hospital, Parel. Amid the pandemic’s second wave last year, Mali was diagnosed with mucormycosis – commonly known as black fungal infection – within a month of recovering from Covid-19 in March 2021.
Mucormycosis is caused by a group of moulds called mucormycetes that are present in the environment. These fungi attack humans battling illnesses such as Covid-19, when the body’s immunity is at its lowest. The infection invades the facial bones and eye orbit and even reaches the brain. The black fungus can lead to visual loss, severe disfigurement and also death.
“Post diagnosis, I underwent three surgeries to remove the infection. A major part of my palate was removed along with nine teeth on the right side of my mouth,” said the Nashik resident, who spent three-and-a-half months in three hospitals across Maharashtra.
Mali, who resumed work in August, now uses an artificial palate and undergoes medical examination once a month to ensure the infection does not recur. “I will undergo plastic surgery within the next three months. My family, friends and seniors have been my biggest support in this tough time,” said Mali, who has spent ₹63 lakh so far on his treatment.
A year after the Ministry of Health and Family Welfare (MoHFW) declared mucormycosis as a ‘notifiable disease’ under the Epidemic Diseases Act, 1897, due to the resurgence of Covid cases in the second wave, survivors of the black fungal infection are crawling back to routine life.
Since May 2021, when mucormycosis was made a ‘notifiable disease’, the state has recorded 10,871 mucormycosis cases — 976 in Mumbai — of which 9,112 patients have been cured, 16 are undergoing treatment and 330 died due to the infection.
Between January 2022 and March 2022, the state reported only 37 mucormycosis cases amid the third wave. But for survivors like Mali, who are awaiting corrective surgeries and continue to have to follow up checkups with the doctors, the struggle is far from over.
Nerul resident Deepak Ayare, 55, lost his left eye and palate to the infection and spent a significant time of his three months in the Intensive Care Unit (ICU) at Vile Parle’s RN Cooper Hospital in 2021.
A non-diabetic, Ayare’s sugar levels shot up when he was infected with Covid-19. He was subsequently diagnosed with mucormycosis. Seven months after the surgery, Ayare got a temporary palate in November and subsequently resumed work.
“For those seven months, I was on a liquid diet and only my wife could understand what I was speaking. I would otherwise communicate with sign language or write,” recalled Ayare, who is the vice-president of a bank.
“I was advised speech therapy with the temporary palate but I have managed on my own, and now there is 90% clarity in my speech. I am yet to get a permanent palate,” he added.
With the sudden loss of vision coupled with disfigurement, a psychiatrist from the city’s largest civic-run KEM Hospital, Parel, said most of the patients displayed sleep issues, anxiety and depression, and required counselling.
“Mucormycosis shocked patients and their families. The onset and prognosis are sudden and severe, leading to disfigurement and loss of sight. It also led to long term hospitalisation with many staying for 2-3 months. Anxiety usually stems from their concern on how they will continue living their lives with deformity,” he said.
Mucormycosis and Covid-19
Given the raging number of mucormycosis cases that afflicted Covid patients, the state government set up a task force for mucormycosis. A large number of mucormycosis cases were seen in Covid-19 patients who had undiagnosed diabetes or uncontrolled sugar levels during the treatment.
Doctors said apart from the unscrupulous use of steroids, non-distilled water used to generate medical oxygen given to patients was among the reasons for the sudden spike in cases.
Dr Kedar Toraskar, critical care specialist, Wockhardt Hospital and state Covid-19 task force member, said apart from conventional risk factors like diabetes and diabetic ketoacidosis and immunocompromised state, Covid-19 virus itself could be an independent risk factor for developing mucormycosis.
“Mucor is iron-friendly and we see a lot of Covid-19 patients having high ferritin levels. This may be one of the reasons for this unique relationship that will have to be validated with studies. Additionally, Covid also causes viral endotheliitis (inflammation of the lining of the blood vessels). Since mucor spreads via the blood vessels, this could be another reason for mucormycosis among Covid patients that needs to be investigated,” he said.
Dr Milind Navlakhe, ENT surgeon, Global hospital, Parel, who had analysed his cases said 20% of patients were diagnosed with mucormycosis on the fifth or last 10 days of getting Covid-19.
“Some patients were at home, not given much oxygen and still got mucormycosis. Some patients didn’t receive steroids and still caught the infection. The only common factor that we saw in our data analysis was all of them had high blood sugar levels at some point in time,” said Dr Navlakhe.
Dr Amol Patil, consulting ENT surgeon at Nanavati Max Hospital, Vile Parle, said from treating one mucormycosis case a year pre-Covid to 25 cases in two months, it became a lot for both doctors and patients to deal with.
Dr Shashikant Mhashal, associate professor, ENT, RN Cooper Hospital, who has operated on 55 patients to date, said, “The infection leads to death of body tissue. Surgical debridement, which involves removing the part affected by mucor, is the only solution. We removed 14 palates and four eyeballs in 55 mucormycosis patients. Early diagnosis of mucormycosis plays a key role in saving life and disfigurement.”
Ghulam Ali Shaikh (39), a small-time businessman from Goregaon, is one of the two mucormycosis cases in Mumbai reported so far this year. In April-end, Shaikh was discharged from Dr RN Cooper Hospital after being in its ICU for weeks since his admission on February 27. Shaikh, who has lost his left eye and palate is presently recuperating at home.
“He is unable to talk properly since the palate is not there. We plan to get him a temporary one within two weeks. Doctors said he will take another six months to get back to normal life,” said Yogita Sutar, his partner.
While doctors aren’t sure if Covid-19 triggered mucormycosis in Shaikh’s case, Sutar said he had Covid-19 symptoms – fever, cough, body ache – a few days before hospitalisation. “We came to know of his uncontrolled sugar levels post hospitalisation. He was otherwise healthy,” said Sutar.
Ongoing study
With fewer Covid-19 cases being reported, the civic body has asked SevenHills – one of its largest Covid-19 facilities – to investigate mucormycosis cases. BMC’s health department said the study is aimed at understanding the interconnection between mucormycosis and Covid-19. Sevenhills had treated 42 of the city’s total mucormycosis cases.