In India, more than 12,000 cases of black fungus have been reported, mostly in patients who are recovering from COVID 19. This severe infection is normally very rare and has a mortality rate of about 50%. According to some medical experts, India has seen more cases of black fungus due to the high prevalence of diabetes. Let’s have a look around the other factors and what’s happening in other countries.

Countries with black fungus cases

Around 38 countries around the world had reported cases of mucormycosis, generally known as black fungus, before the coronavirus pandemic. However, according to Leading International Fungal Education, India and Pakistan had recorded the highest rates with around 140 cases per million annually.

An expert on fungal infections, Dr. David Denning at the University of Manchester said that reported cases of black fungus in India were “masses more than any other part of the world” well before the pandemic.

He said black fungus is strongly linked with poorly controlled diabetes and there’s a lot of diabetic patients in India. According to a recent research paper looking at the cases globally found that that patient recovering from COVID 19, almost 94% of those who has fungal infection also suffered from diabetes.

Meanwhile, the majority (71%) of the reported cases of black fungus were from India.

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Has black fungus been linked to diabetes in other countries?

Other top countries with a high per-capita prevalence of diabetes also reported cases of mucormycosis. Pakistan and Bangladesh, both the countries have a high prevalence of diabetes in their populations and have had cases of black fungus but not in large numbers.

Bangladesh has one confirmed case of mucormycosis and is awaiting the test results for another suspected case. Doctors said both the patients also had diabetes, reported BBC. In recent weeks, Pakistan reported five cases case of mucormycosis, reportedly four of them died as of May 12.

On other hand, Brazil reported 29 cases so far but it’s still not clear how many of those had COVID or were diabetic. Russia has also reported “isolated” cases of mucormycosis in COVID patients but it’s unclear how many been detected till now.

While the US has a very high prevalence of diabetes and 9.3% of the population is estimated to have the condition. The US also has the highest number of COVID cases globally. According to the US Centers for Disease Control, mucormycosis is very rare and diabetes cases there are largely managed with only 3% going undiagnosed.

Diabetes as a risk factor

Experts say the levels of undiagnosed diabetes are the main issue rather than the recorded cases of diabetes. About 57% of those with diabetes in India, Nepal, Bangladesh, Sri Lanka are undiagnosed cases and nearly all of these are found in India, IDF estimated. The neighboring country, Pakistan is also estimated to have a high proportion of undiagnosed diabetes.

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Dr. Harisprassth Prakash at the International School of Medicine in Kyrgyzstan, says there is a lot of uncontrolled diabetes in India because people don’t do regular health check-ups. He also said that majority of diabetes cases are discovered through other health complications and remain untreated.

Uncontrolled or poorly controlled diabetes can put you at higher risk of infections, including some fungal ones. According to Dr. Denning mucormycosis cases might be going undiagnosed as it not the easiest thing to diagnose. 

Other causes of black fungus

Experts also suggest that mucormycosis or other fungal infections might be linked to the indiscriminate use of steroids for some COVID treatments. WHO had prescribed two steroids – dexamethasone and methylprednisolone, to treat COVID patients in India to reduce the inflammation caused by the body’s immune response. 

However, hospitals and doctors were overwhelmed by a growing number of cases of black fungus, there’s evidence that these prescribed steroids are being taken without any medical supervision. Although, Indian authorities have recently warned against such self-medication as it may cause serious harmful consequences. 

UK conducted a trial on around 2,000 COVID patients which showed that dexamethasone helped reduce mortality in those with moderate or severe infection but it could potentially be harmful to those with mild infection. However, in India, some states are reported to have distributed dexamethasone to the public along with home isolation kits.