Amid the onslaught of coronavirus as India battles with alarming increase in deadly black fungus cases even as equally lethal white and yellow fungus infections are trickling in, more varieties of fungi-induced diseases, with some showing Covid-19 like symptoms, cannot be ruled out, going by the report of the national public health agency of the US, Centers for Disease Control and Prevention (CDC).
According to the reports, there are about six million diverse species of fungi, ranging from common companions such as baking yeast to wild exotics. Unlike animals, they have cell walls, not membranes; unlike plants, they cannot make their own food; unlike bacteria, they hold their DNA within a nucleus and pack cells with organelles — features that make them, at the cellular level, weirdly similar to us. Fungi can be present everywhere, whether rocks, plants, clouds, skin or guts.
Among the several million species, only around 300 fungi are known to cause human disease.
Some of them are Mucormycosis (black fungus) and Aspergillosis. Another deadly fungus like Candida auris, Covid-19-associated pulmonary aspergillosis, blastomycosis and fungal pneumonias to name a few that too can occur at the same time as Covid-19 pandemic.
Yellow fungus is known as mucor septicus while white fungus is Candida auris.
Other fungal diseases, such as Valley fever (coccidioidomycosis), histoplasmosis, and blastomycosis, can cause fever, cough, and shortness of breath, similar to Covid-19 and bacterial pneumonias.
To complicate the matter further for detection, some patients can have Covid-19 and a fungal infection at the same time. In fact, some reports said hospitals near Los Angeles that were handling Covid patients had some of them developing additional fungus infections called Candida auris.
According to a report, there are possibly 300 million people infected with fungal diseases worldwide and 1.6 million deaths every year - more than malaria, and as many as tuberculosis. Just in the US, the CDC estimates that more than 75,000 people are hospitalised annually for a fungal infection, and another 8.9 million people seek an outpatient visit, costing about USD 7.2 billion a year.
In India, the situation may be more alarming in coming days in view of the high and underlying diabetes cases with uncontrolled sugar and misuse of steroids for Covid treatment. Also fungus lurks on the weak immune system caused by chronic diseases like kidney ailments and heart related diseases.
The CDC has suggested laboratory testing is necessary to determine if a person has a fungal infection or Covid-19.
People with severe Covid-19, such as those in an intensive care unit (ICU), are particularly vulnerable to bacterial and fungal infections, said the CDC adding that awareness of the possibility of fungal co-infection is essential to reduce delays in diagnosis and treatment in order to help prevent severe illness and death from these infections.
Similarly, aspergillosis fungus has been increasingly reported in patients without weakened immune systems, but those who have severe respiratory infections caused by viruses, including influenza. Several recent reports describe Covid-19-associated pulmonary aspergillosis (CAPA), as per the CDC.
CAPA, which usually occurs in patients with severe Covid-19 (e.g., patients on ventilators in ICUs), can be difficult to diagnose because patients often have non-specific symptoms and testing typically requires a specimen from deep in the lungs. It can cause severe illness and death.
Another fungus that can spread at a rapid pace during the Covd-19 pandemic is Candida auris. It is an emerging fungus that can cause outbreaks of severe infections in healthcare facilities.
These outbreaks may be related to changes in routine infection control practices during the Covid-19 pandemic, including limited availability of gloves and gowns, or reuse of these items, and changes in cleaning and disinfection practices.
Similarly, patients hospitalized for Covid-19 are at risk for healthcare-associated infections (HAIs), including candidemia, or bloodstream infections caused by Candida.