WHY MUCORMYCOSIS(BLACK FUNGUS) CAN NOT BE DECLARED AS EPIDEMIC IN INDIA

While the whole world is under attack of a second wave and of a more severe potent mutant form of SARS CoV-2 virus causing SEVERE COVID 19 PNEUMONIA pandemic ,a new disease is on the verge of getting declared as an epidemic named MUCORMYCOSIS OR BLACK FUNGUS (in common term). MUCORMYCOSIS is an umbrella term used for an opportunistic infection caused by several fungi belong to GLOMEROMYCOTAFAMILY(mucor, zygomucor,lichtheimia,syncephalastrumetc) these saprophytic fungi can be found in soil,food damped walled in the environment which were actually considered as an non pathogenic organism to human. In current days it has become an emerging disease in the world especially in india. Now the COVID ASSOCIATED MUCORMYCOSIS has raised a severe threat and fear in india during these second wave of CORONAVIRUS INFECTION.Due to irrational use of the drug PREDNISOLON OR DEXAMETHSONE(which basically belong to steroid group of drugs) for the management of COVID 19 AQUIRED PNEUMONIAMOR,ESPECIALLY FOR THOSE WHO ARE ON HIGH O2 REQUIREMENT has raise 2 issuesone is improper glycemic control,second is severe immunosupressant stage HERE IS A CASE REPORT THAT CAN PROVE THAT CASES OF MUCORMYCOSIS WERE INEVIDENTLY PRESENT IN INDIA EVEN BEFORE THIS PANDEMIC STARTED. A 40 years old male,a cotton mill worker ,was admitted in the emergency observation ward OF IPGME&R AND SSKM HOSPITAL,KOLKATA AROUND THE MONTH OF OCTOBER IN 2018 with random blood glucose level(RBS) 702 gm/dl along with a history of necrotic oral ulcer over the hard pallete extending posteriorly along with left sided nasal blockage with complaint of difficulty to eat and swallow both liquid and solid and rhinolalia since 45 days. There was no history of fever,cough,haemoptysis,no history of trauma to the affected site or tuberculosis. At this point with a high RBS and elevated urea creatinin level patient was diagnosed to be in diabetic ketoacidosis and he was managed with iv. Insuline and hence forth his blood glucose level was kept under control with insulin therapy. While taking the history it came into our notice that the patient is a known case of type 2 diabetes mellitus and CKD-STAGE V due to IgA Nephropathy for which he was receiving Prednisolon which he suddenly discontinued 15 days before admission and he also underwent haemodialysis twice. On local examination he had a necrotic ulcer over the hard palate and necrotic debris in the nasal cavity(as evident in the nasal endoscopy).CT —nose+PNS showed left sided maxi antrum opacity suggestive of pansinusitis . All broad spectrum antibiotics along with iv voriconazol was started as the patient was immune compromised.