Steroids not the issue, weakened immune system is, doctors say
A 65-year-old man recently died while undergoing treatment for post Covid-19 complications, and samples of the deceased tested at Birdem General Hospital (BGH) in Dhaka came back positive for mucormycosis, or black fungus, on Monday.
This is the first confirmed case of black fungus in a recovered Covid-19 patient in Bangladesh.
BGH Head of Microbiology Dr Shariful Alam Jilani told Dhaka Tribune the presence of the fungus was found in the bronchoalveolar lavage (BAL fluid), which is usually collected from the lungs.
Dr M Delwar Hossain, head of respiratory medicine at the hospital, said he was yet to receive the full report on the patient, but black fungus was definitely suspected. The patient tested positive for Covid-19 a month ago in Khulna.
“He was admitted to the hospital with post-Covid-19 complications. He had diabetes as well. The patient died three days ago,” he added.
Health officials said the black fungus had also been found in the sputum of two other patients, both from Satkhira. One of the patients was detected with black fungus on May 8, and the other on May 23.
IEDCR said it was yet to be informed of the findings by the hospital authorities.
Black fungus, also known as mucormycosis, is normally a rare infection which has a mortality rate of 50%.
According to doctors, there is a link with the steroids used to treat Covid-19, and diabetics are at particular risk. The fungus seems to strike 12 to 18 days after recovery from Covid-19.
Weak immune system increasing risk
For severely infected Covid-19 patients, steroids are usually prescribed. The use of steroids to treat Covid-19 increased significantly around June last year, as several studies found that it could be effective in the treatment of severe cases.
The World Health Organization in its interim guideline published in September last year said severe and critical Covid-19 patients with oxygen suppression should be given the corticosteroids.
It also recommended against using corticosteroids in the treatment of patients with non-severe Covid-19, unless the patient was already taking the medication for another condition.
Corticosteroids are a type of anti-inflammatory drug. Several doctors at hospitals providing treatment to Covid-19 patients said alternatives to corticosteroids in the treatment of the virus were yet to be found.
According to the 9th version of the National Guidelines on Clinical Management of Covid-19 published by the DGHS this month, three types of corticosteroids are given to critical or severe patients in different quantities.
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Prof Delwar Hossain said this was not the first time that the hospital had seen the black fungus.
“This fungus exists naturally in the environment. It has gained attention because of the situation in India,” he said.
“Steroids are not the issue here. The issue is that when the immune system weakens following critical treatment, it increases the risk of potential infection. It happens in rare cases,” the doctor added.
Centre for Medical Biotechnology Deputy Program Manager Marufur Rahman Opu said that the fungal disease did not arrive from India.
“The fungus already exists in the environment of the country. The spores enter the body when we breathe, but it usually does not affect people because their immune systems are normally strong enough to suppress it,” he added.
Opu further said people should not take steroids for Covid-19 treatment without consulting doctors, explaining that though they may be effective, they also weaken the immune system.
Govt starts preparing for surge
Dr Nazmul Islam, one of the spokespersons for Covid-19 management at the DGHS, on Sunday said the DGHS was preparing a guideline considering the black fungus and that it would be disseminated to district units soon.
Officials from the DGHS said a formulation of the guideline was yet to be completed.
Meanwhile, Health Minister Zahid Maleque said rising infection rates across the country were no cause for panic, as the government had already started taking preparations to handle the problem.
“Along with Covid 19, the rare black fungus has reached the country. The country needs to fight both diseases, but there is nothing to be worried about as it is yet to spread across the country,” he said,
“As part of prior measures, the authorities concerned have already been asked to formulate new clinical guidelines to treat patients,” the minister added.
“Besides, I have already instructed the pharmaceutical companies to start manufacturing medicines required for fungal treatment, in case the number of black fungus patients increases," he further said.