No white fungus cases in Karnataka, high-risk one is still Mucormycosis: Doctors

Bengaluru: While black fungus has been elevated to epidemic status, a new kind of fungal infection -- termed as 'white fungus' -- has been reported in Patna, Bihar. But experts said that no such cases have been seen in Karnataka so far. They claimed that fungal infections have been reported among many immunocompromised patients, especially those who have recovered from Covid after staying in ICUs.

"Just as mucormycosis has been loosely called 'black fungus', other fungal infections, for example, superficial and invasive candidiasis, invasive aspergillosis, etc, are now being termed as 'white fungus'. Though we used to see them in patients with very low immunity, cancers and those who have undergone organ transplant, there is a sudden rise of these infections in Covid-recovered patients due to widespread use of steroids.

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Other factors, including hygiene, may also be responsible. These infections are generally difficult to treat. The famous adage 'prevention is better than cure' is apt in this situation," said Shashikiran Umakanth, Professor & Head, Department of Medicine, Dr TMA Pai Hospital, Manipal University. Dr Ravindra Mehtra, Pulmonologist, Apollo Hospitals, said that Apollo Hospitals saw 10-15 aspergillosis patients over the last few weeks and it is usually caused by inhaling aspergillus spores.

Most people inhale these spores every day without being affected. But if the immune system is weak, infection is more likely because it is an opportunistic fungus. Doctors said the high-risk one is still mucormycosis or black fungus followed by aspergillosis.

Then comes candidiasis, also known as thrust, caused by yeast -- which is another type of fungus, triggering white blisters in the mouth and private parts. Dr Satyanarayana Mysore, Senior Pulmonologist, Manipal Hospitals, said, "White fungus belongs to the family of candida. It can affect lungs, nails, brain, skin and even genitals. But we have not seen such cases so far, and people need not panic."

Doctors said that more needs to be known on Bihar cases that presented Covid-like symptoms but did not test positive in RTPCR. Among the infected is a doctor and experts said that it could be due to hospital exposure. Aspergillosis is not life-threatening as it doesn't spread as rapidly as mucormycosis. While treatment for aspergillosis is through Vovoriconazole medications, candidiasis can be treated with oral medicines like fluconazone.

"Superficial urinary tract infection and oral candidiasis require therapy for just 14 days. Patients may do well with oral medications. But invasive infections require IV therapy with drugs like Caspofungin, Anidulafungin and Micafungin, and the duration of treatment may be 14 days to six weeks," the doctors said.

Dr. Rohini Kelkar, Consultant, Clinical Microbiologist and Specialist, Metropolis Healthcare Ltd. said "the term 'White Fungus' can apply to the white colonies of an environmental fungus or a 'Yeast'. Such yeasts called Candida are found in the mouth, throat and the gut called as 'Endogenous' flora.

​They replace the normal protective bacteria on the skin, mouth and gut, in patients given broad-spectrum antibiotics. These microorganisms can cause "Endogenous" infections or from "within" in Covid patients treated with steroids or immune-compromised.

"These infections are called 'Opportunistic' infections. Such fungi do not cause disease in normal individuals." Dr Rohini added.

In Post-Covid patients who develop symptoms of infection like fever, cough etc, it is important to have a high index of suspicion and perform laboratory tests to accurately and rapidly diagnose the agent/fungus causing infection to save their lives with the correct treatment.

The laboratory results need proper interpretation as these fungi are often present as contaminants. Specialized tests and professional interpretation by qualified laboratory physicians is essential.

Symptoms of Aspergellosis

Fever, chest pain, cough

Coughing up blood

Shortness of breath

Other symptoms can develop if the infection spreads from the lungs to other parts of the body

Symptoms of Candidiasis

Tiredness and fatigue

Recurring genital or urinary tract infections

Digestive issues

Sinus Infections

Skin and nail fungal Infections

Joint pain

Need thorough study

A senior doctor at AIIMS, Delhi said she has been treating autoimmune disease patients with steroids for years, but mucormycosis cases were rare. "Something has changed now. Whether it is the use of industrial oxygen or the way oxygen has been instituted in health facilities, I am not sure. That is for researchers to find out."

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