Dr Samir Bhargava is one of the best and renowned ENT Specialists in Mumbai. He has over 30 years of experience as an ENT Doctor. He is the National President of the ENT association of India. Dr Bhargava is known for his friendly approach and human attitude towards his patients.
While talking to our Editor-in-Chief Dr Vaidehi Taman, he throws light on ongoing colour theories of various fungal infections and the humorous media coverage. Following are excerpts of this interview:
These days we are hearing about Black/Yellow/White Fungus, who is colouring it?
Actually (Doctor smiles and says), we should ask “fungus tere kitne rang?”. Unfortunately, certain doctors have labelled the colours. To tell you very frankly, the black fungus itself is a misnomer. None of these fungus’ that we are tackling are black, white, or yellow. They don’t have their colours.
Depending upon the medium that it is grown and the time that is seen can have various colours. Mucor is called Black fungus for the simple reason that it damages the blood circulation, causes the tissue to become dead and that tissue first becomes white because it does not have a blood supply and then becomes black because it is dead tissue. That is actually a reason why it is a black fungus.
White fungus is Candida infection. We see a lot of Candida in the ear, mouth and it is non-invasive. The yellow discolouration can happen in Aspergillus fungus. But none of these is labelled in any microbiology textbook as White, Yellow, or Black. This terminology is given in the Indian subcontinent.
Why this Yellow fungus is in news with its horrific nature?
There is some doctor from Uttar Pradesh who broke this news to the media, may be to remain in limelight though there is no such fungus emerged so far to my knowledge. These days’ people want to make a comment stating something unusual or different to create some sensation. Mucor definitely does not have these colours.
What is the relevance of these colours with fungus?
When you talk about white fungus, it is Candida. Candida forms a bed of white. In monsoon, if you see any tissue paper where you see these black dots, it’s Aspergillums Niger. Mucor never had any of these colours.
How true are the reports of people losing vision due to black Fungus and now there are special wards to deal with it?
In Bombay among the four Medical colleges around 190 patients are admitted for treatment of Mucormycosis. It enters through the nose and via bloodstream can go into the eye as the orbit is in close relation. It damages the vision and can also cause Intracranial problems. That is definitely a known entity. At Cooper hospital, in the last week, three patients’ eyeballs had to be removed. That is an entity and unfortunately is a reality.
Is our country or Mumbai facing any shortages of these medicines?
Mucormycosis is considered a rare fungal infection. Not only Mumbai but also the whole of India is facing a shortage. The drug of choice is Amphotericin-B, which is an anti-fungal. There are two types of Amphotericin is a conventional cheaper type but that can be nephrotoxic so the kidney reaction can rise.
The other one is called liposomal Amphotericin-B, which’s very expensive. Each vial can cost Rs 7500, and you need a minimum of six vials per day for the patient every day for a minimum period of Fourteen days.
The therapy cost Rs 40,000 to Rs 50,000 before COVID times and now the people have jacked up the price.
In a year, my entire institute would see three or four cases of Mucormycosis, Similarly, all the centre’s of the country had that many cases, where was the requirement for Amphotericin-B? That’s why medicines production was very little. And now as we speak 10,000 patients reported all over India and rising. So that’s why there is a shortage.
Initially, there may have been some hoarding, but now there is a genuine shortage and they need to produce more and limited companies are making that. It is under the centre’s control so they are distributing from there. Maharashtra has ordered one lakh vials; Rajasthan has ordered so many more, every state is ordering. Let us see how early the supply is delivered.
What causes this kind of Fungal Infection?
There are two types of infections, Invasive and Non-Invasive. This is an Invasive Fungus, which attacks other parts of the body. It is an opportunistic infection. This means that if our immunity is good, even if we get exposed to the Mucor fungal spore, we will not get this infection. We will get this infection only and only if our immunity is low. Covid-19 this particular variant has caused the immunity to be lowest, so the main reason is the new strain of the virus. Other than other patients have received high doses of steroids. Most of these are diabetic or Pre-diabetic because of the steroids; their sugar level goes up.
Last year too I saw Mucor, but still, numbers were very small. Now we are seeing so many patients.
Other factors are oxygen, which is humidified, is given to patients from faulty contaminated containers and people not washing them. Fungus is in the ground or we can say in the soil. Mucor spores are in the soil and they get picked up from there. Personally, I feel that all these things are common, only the different variant that’s we got this mucor.
Is it contagious?
No, it is not contagious. Doctors are operating patients but not getting infected because their immunity takes care of their wellbeing. The port of entry is through the nose only.
What are the challenges of treating such patients?
The biggest challenge is that this disease spreads very fast. It can spread within hours to days into the eye and the brain. If it goes to the brain the mortality is 80% to 90%. If it goes into the eye the chances of losing vision and if sinus affected, one may have to remove the major part of the sinus and then it goes to the palate. So some of these people lose their teeth and half of their palate. These are challenges as far as the disease is concerned.
Another challenge is that the medicines are nephrotoxic, and can affect the kidneys of the patient. The cost, the medicines are expensive. Psychological damage is a major issue. One can end up saving one’s life, but without an eye, the person may face emotional trauma. The lists of challenges are very long but what one needs is a will, to get cured and treat.
What would be your advice to the people to stay away from these kinds of infections?
Mask, Mask and Mask, if one wears a mask neither the virus nor the fungus can enter into the nose or mouth. Also, get vaccinated because with vaccines the chances of being infected are less and prevention is better than cure. Also, maintain hygiene in all ways. Maintain sugar levels. Every patient who goes home, who is diabetic should monitor the sugar.
Unfortunately, people were given steroids, which was required at that time as it was saving lives, but sadly did not get Glycemic control. Many patient’s sugars go haywire, as it never gets checked. Today if you give a patient any medicine, you have to look at the side effects also. If you don’t monitor that, why give medicine a bad name?
There was a report about those who have been vaccinated will die within two years?
That is some rubbish forward. The claim is fake and the Covid-19 vaccine is completely safe. Vaccines are not new and have been around for many years. Because of vaccines, you don’t have smallpox or polio. They have been proven over the period of time and any new treatment comes in, it becomes a challenge till it becomes the norm and then nobody encounters it.
Being a doctor, have you ever got disturbed by these rumours?
Awkwardly, people doubt all the good intentions. If people scream from rooftops about something is false, even if that is genuine the news starts appearing as false. That is the disadvantage of forwards and circulations.
Those who can shout hundred times will have more impact than someone who shouts five times. Controversial the statement, more attention it draws. People don’t even think before forwarding fake news. Forwards are a curse these days.
Coming back to our main question, nobody is colouring the fungus, the fungus itself has no colour that you want to say?
Mucor is definitely not exhibiting these colours, these are colours that we are labelling because of certain changes that are taking place but it’s a misnomer and all these colours are wrong. The best person who can comment on a fungus is a Microbiologist. And the best microbiologist in the country also does not know from where these colours have originated. When a media person spoke to a microbiologist, he hilariously said that I have to refer my books to see what is written there.
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