The pandemic hasn’t just given us COVID-19 to worry about – there are variants, there are post-COVID complications, the black fungus, and now, green fungus. In what appears to be one of the first such cases recorded in India, a paediatric physiotherapist in Bengaluru underwent treatment for ‘green’ fungus infection (Aspergillus fumigatus) at the BGS Gleneagles Global Hospital in Bengaluru.
Dr Prashanth R Reddy, Chief Consultant, ENT and Endoscopic Skull Base Surgeon, at the hospital spoke to TNM about how they went about detecting and then treating the infection. The patient – Dr Karthikeyan R – underwent an endoscopic surgery through his nose on June 15, 2021, where the fungal infection was spotted in his sinus area.
Dr Reddy explained that usually, in the case of a black fungus or mucormycosis infection, there is black crust formation. “But we found a different kind of presentation on opening up the maxillary sinus. During an infection, the sinus is filled with pus, and some elements of the fungal infection will be seen grossly. However, it did not show the signs of a classical mucor infection and had a different texture, with a brown-greenish hue,” Dr Reddy says.
After the samples were sent to histopathology (the diagnosis and study of disease in tissues), the differently-coloured crystals were seen. The hispathology also revealed signs of both black and green fungal infections. The microbiological analysis diagnosed that it was an infection caused by Aspergillus fumigatus. “This patient’s case was that of a mixed infection of black and green fungus,” Dr Reddy observes.
Dr Prashanth Reddy did an endoscopic surgery, where the dead tissue where the infection was occurring, was cleared.
He explains that fungal infections such as the above occur because of the dead tissue that COVID-19 leaves behind. “These fungal spores are common and present in the air and soil. We have even found them in a healthy person’s nose and mouth. But what is happening now are opportunistic infections – fungus will grow on anything dead and decaying,” Dr Reddy states.
However, aspergillosis infection is not commonly seen in humans. And mucormycosis is more aggressive. “Mucormycosis spreads via the blood vessels, so it can practically infect any tissue in the body. It uses the iron content in the blood, which gives it its black colour. Green fungus, on the other hand, is surface invasive. It cannot go via blood vessels.”
To treat Dr Karthikeyan, one of the treatments Dr Reddy prescribed was posaconazole, a broad-spectrum antifungal drug. While Amphotericin has been in the news for treating mucormycosis, Dr Reddy warns that it is a double-edged sword and could impact a person’s kidneys if overused.
In post-COVID cases, where most mucormycosis cases are being seen, Dr Reddy cautions that just an antifungal drug is not enough – “first, you have to remove the dead tissue, and then give the antifungal medication,” Dr Reddy states.
Dr Karthikeyan came to Dr Reddy around a month after recovering from COVID-19 when he had some swelling in his cheek. According to TNIE, which first reported the story, Dr Karthikeyan also experienced heaviness in his face, nasal discharge along with a headache. “Since he had a medical background himself, he was taking some antibiotics that slowed the spread of the infection. But it wouldn’t have solved the problem as it didn’t take out the dead tissue,” Dr Reddy says.
Dr Reddy explains that the progression of a fungal infection like mucormycosis can be broken into three stages: cheek pain, teeth pain, eye pain (stage 1); redness on the cheek, swelling of cheek and/or the eye, falling teeth (stage 2); discolouration of the cheek, nose, eyes (stage 3). A crucial symptom that can occur in any of the stages is blurring of vision, and patients experiencing the same should immediately get medical help.
As for Dr Karthikeyan, Dr Reddy says that it will only be 2-2.5 months before he can declare the patient cured of the black and green fungal infections.