Sunday, 30 May 2021 | PNS
25% of infected patients don’t go for treatment due to huge cost; 54% die even after treatment
The deadly fungal infections, particularly black fungus (mucormycosis), which have assumed alarming proportions among the Covid infected/survivors are leaving their kith and kin of the infected mentally, physically and financially drained.
Unable to bear the exorbitant treatment costs, at least 25 per cent of the fungus-infected patients either refuses to continue with the treatment or do not opt for it, leaving themselves on their fate, doctors said. “Most of them might not have survived,” Dr Arunakole Chakabarti, head of the department of microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, said and asserted that there is a need to bring down the cost as well as ensure a system to support them financially, before they move into BPL category due to out of pocket expenditure.
Though majority of States having high caseload of black fungus have notified the disease, the authorities are silent on the increasing cost which is leaving patients high and dry to arrange short supplied life-saving drugs — Liposomal Amphotericin B — in the market. Majority of patients are being forced to shell out hefty amount, ranging from `8,000 to over `10,000 for a vial.
To make the matter worse for the patients, at least 54 per cent opting for treatment succumb to the disease. A serious but rare fungal infection, mucormycosis is caused by a group of molds called mucormycetes. If not treated on time, it can leave one blind or with organ dysfunction, loss of body tissue and even death. Over 12,000 fungus infections, including mucormycosis, cases have been reported till date from across the country. Deaths are registered daily.
Dr Rahul Bhargava, Principal Director of the Hematology Division at Fortis Memorial Research Institute, Gurugram, said treatment cost varies, depending on the gravity of the disease.
But usually, it can be around `5 lakh a week incurred on equipment, investigations, room rent and surgery besides vial cost, he said.
“Main treatment involves costly antifungal medicines and injections (which are in short supply) and tedious surgeries by a battery of surgeons — ENT, ophthalmologist, Faciomaxillary, neurosurgeon and reconstructive surgeon. This all cost money,” he explained.
Dr Bhargava said a 5mg dose is needed per kilogram (kg) of body weight. Hence, if a person is 70 kgs, he would require 350mg of the dose. So, a patient needs at least eight vials which costs `70,000 daily.
Chakrabarti, who manages the WHO Collaborating Centre for Reference and Research on Fungi of Medical Importance at PGI, Chandigarh, said it has been noticed that quite a few hospitals are prescribing a cocktail of drugs, including doxycycline, ivermectin, steroids etc.
Often, hospitals prescribe dexamethasone five times more than what has been recommended by the WHO. Dexamethasone should not be more than 6mg in Covid-19 patients, which is being given 30mg at times. This is increasing glucose levels affecting the other parameters and making mucor conducive for growth.”
He suggested that if Liposomal amphotericin is not available, doctors can use amphotericin B deoxycholate. “At our WHO Centre we are teaching them how to reduce toxicity triggered by these drugs.”
“Many patients who cannot afford the treatment cost do not come again after they are told about the expenses they would have to incur,” he said as also was highlighted by a study conducted by him a few years ago.
In the study “Mucormycosis: Battle with the Deadly Enemy over a Five-Year Period in India,” published in Dr Chakrabarti along with a string of other experts examined at least 82 cases of mucormycosis.
Most common presentation was rhino-orbito-cerebral (37), followed by cutaneous (25), pulmonary (14), oral cavity involvement (4) and gastrointestinal (2). The most common risk factors were diabetes and intramuscular injections, the study said.
The mainstay of the treatment was amphotericin B, along with extensive surgical debridement whenever feasible. “Around 50 patients recovered but 25 dies. The rest left against medical advice,” they said, maybe because they could not sustain paying the hefty bills.
“Nip in the Bud” should be the mantra for clinicians/surgeons for a favorable prognosis.
“Early diagnosis, prompt institution of appropriate antifungal therapy, surgical debridement whenever necessary, knowledge of risk factors and their timely reversal is the key for management,” said the study.
“In the second wave, the infection rate is not only more but it is also affecting younger patients also. We are even seeing kids being affected by the black fungus after they get Covid. Also, the infection is so lethal that it is quickly spreading to eyes, palate and even brain,” said Dr Nita Radhakrishnan, HOD, Department of Paediatric Haematology-Oncology, Super Specialty Paediatric Hospital and PG Teaching Institute (SSPHPGT), Noida.
Dr Bhargava agreed, pointing out that they are investigating a three-year- old- girl child case who has been detected with black fungus on the skin after she recovered from Covid and bone marrow transplant was done on her for her blood disorder condition, thalassemia.
