Thread by @DrEricDing

Unusual rise in rare fungal infection in #COVID19 patients, especially with diabetes—can lead to blindness.

"Diabetes lowers the body's immune defences, coronavirus exacerbates it, and then steroids which help fight Covid-19 act like fuel to the fire” 🧵
bbc.com/news/world-asi…

2) “Inside the surgery, an ear, nose and throat specialist was already at work on the patient, a diabetic.
Dr Nair had inserted a tube in her nose and was removing tissues infected with mucormycosis, a rare but dangerous fungal infection.”

3) “This aggressive infection affects the nose, eye and sometimes the brain.
After his colleague finished, Dr Nair would carry out a three hour procedure to remove the patient's eye.
"I will be removing her eye to save her life. That's how this disease works," Dr Nair told me.

4) “Even as a deadly second wave of Covid-19 ravages India, doctors are now reporting a rash of cases involving a rare infection - also called the "black fungus" - among recovering and recovered Covid-19 patients.

5) “Doctor believe mucormycosis, which has an overall mortality rate of 50%, may be being triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients.

6) “Steroids reduce inflammation in the lungs for Covid-19 and appear to help stop some of the damage that can happen when the body's immune system goes into overdrive to fight off coronavirus. But they also reduce immunity in both diabetics and non-diabetic Covid-19 patients.”

7) “It's thought that this drop in immunity could be triggering these cases of mucormycosis.”

8) “Dr Nair - who works in three hospitals in Mumbai, one of the worst-hit cities in the second wave - says he has already seen some 40 patients suffering from the fungal infection in April. Eleven of them had to have an eye surgically removed.”

9) “Between December and February, just six of his colleagues in five cities - Mumbai, Bangalore, Hyderabad, Delhi and Pune - reported 58 cases of the infection. Most of the patients contracted it between 12 to 15 days after recovery from Covid-19.”

10) “Mumbai's busy Sion Hospital has reported 24 cases of the fungal infection in the past two months, up from six cases a year, according to Dr Renuka Bradoo, head of the hospital's ear, nose and throat wing.
Eleven of them had to lose an eye, and six of them died.”

11) “Most of her patients are middle-aged diabetics who were struck down by the fungus two weeks after recovering from Covid-19. "We are already seeing two to three cases a week here. It's a nightmare inside a pandemic," she told me.

12) “In the southern city of Bengaluru, Dr Raghuraj Hegde, an eye surgeon, tells a similar story. He has seen 19 cases of mucormycosis in the past two weeks, most of them young patients. "Some were so sick that we couldn't even operate on them."

13) “Doctors say they are surprised by the severity and the frequency of this fungal infection during the second wave, compared to some cases during the first wave last year.

14) “Dr Nair says he has come across not more than 10 cases in Mumbai in the past two years. "This year is something different," he says.
In Bengaluru, Dr Hegde had never seen more than one or two cases a year in over a decade of practice.”

15) What is mucormycosis? …. It’s pretty common fungus. The issue is the confluence with both COVID infection and steroids.