‘Black fungus’ cases threaten to overwhelm the public health system in Telangana

Published : May 24, 2021 16:07 IST

The Government ENT Hospital in Koti was recently turned into the nodal centre for admission and treatment of patients with Mucormycosis or Black Fungus in Hyderabad. Photo: Nagara Gopal

With the number of patients stricken with mucormycosis, the dreaded ‘black fungus’ infection, in Telangana growing exponentially and graphing a near vertical trend line, the Kalvakuntla Chandrashekar Rao government has decided to increase fourfold the number of dedicated beds available to treat the disease. Depending on the severity of the disease, each patient needs upwards of 21 vials of Liposomal Amphotericin B, the anti-fungal drug being recommended for treatment of the infection. With the State still not in possession of adequate stocks of the drug, treatment of the disease has already turned out to be a nightmare.

Doctors treating black fungus patients told Frontline that a week ago, that Telangana had just 300 vials of Liposomal Amphotericin B. But with the Union government stepping in to supply 1,050 vials, the position had marginally improved “for the moment”. Based on the State’s caseload, D.V. Sadananda Gowda, the Union Minister for Chemicals and Fertilizers, announced on May 22 that his Ministry had released 890 more vials of the drug to the State.

On May 19, Telangana had officially reported 59 cases of mucormycosis. By May 22, the number has spiralled to over 240, and by May 24, to over 1,000. The government has designated two state-run hospitals as black fungus nodal treatment centres - the District ENT Hospital at King Koti, Hyderabad and the Gandhi Government Hospital, Secunderabad. While the ENT Hospital will cater to patients who have recovered from COVID-19 and have then been infected with mucormycosis, the Gandhi Hospital - Telangana’s biggest government hospital - will treat those who are active COVID-19 cases.

Further, the situation has forced the Telangana government to set up an additional ward at the ENT hospital. The hospital, which has currently earmarked 50 beds for such patients, is in the process of adding 150 more beds. The Gandhi Hospital, a dedicated COVID-19 hospital, has reserved 150 beds to treat black fungus cases; nearly all these beds are occupied now. The number is growing by the hour.

Speaking to Frontline, Dr Raja Rao, Superintendent, Gandhi Hospital, said that with nearly 50 per cent of patients probably needing surgery, the hospital had set up a committee consisting of an ENT specialist, an ophthalmologist, a plastic surgeon, a neurosurgeon, and a dentist to evaluate each case of black fungus. Said Raja Rao: “We are providing anti-fungal treatment. Mucormycosis or black fungus is not a rare disease. The reason why we are seeing more cases this year is because there are more COVID-19 cases. Mucormycosis mostly affects diabetic patients who are admitted to the ICU for other ailments and not just for COVID-19. We have seen it in the past too in patients with uncontrolled diabetes. Black fungus mostly effects immunocompromised patients. Any viral infection can trigger mucormycosis. And it can affect the brain, the eye, and the sinuses.”

In a bid to regulate the supply of Liposomal Amphotericin B, the Telangana government has set up an expert committee that will vet each application for the drug. Sources told Frontline that until May 22, the expert committee had received more than 700 applications for Liposomal Amphotericin B as well as the alternative drugs Posaconazole and Isavuconazole.

According to a doctor, adequate quantities of Liposomal Amphotericin B will not be immediately available as pharmaceutical companies have almost stopped manufacturing it and would have to import raw material from countries such as Germany in order to resume production.

The State has already reported six deaths due to mucormycosis.