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Is diabetes behind the high number of cases in India?

Mucormycosis affects the sinuses, which may require surgery to remove the eye.

Mucormycosis affects the sinuses and may require surgery to remove the eye.

About 1

2,000 cases of so-called “black fungus” have been reported in India, most of them in recovering COVID-19 patients.

This severe infection is extremely rare and has a mortality rate of approximately 50%.

Some medical experts suggest that India has an increase in cases due to the high prevalence of diabetes.

But are there other factors at work and what’s going on in other countries?

Which countries have black mold?

Before the coronavirus outbreak, at least 38 countries around the world had reported cases of mucormycosis, commonly known as black fungus.

India and Pakistan have the highest rates of about 140 cases per million per year, according to a leading international fungal study.

with the increasing number of patients  A special ward has been established for patients with mucosal disease.

Special mucosal disease department in a hospital in the Indian state of Gujarat.

Dr. David Denning from the University of Manchester Fungal infection experts say there are reports of black fungus cases in India. “Mass more than the rest of the world” before the pandemic

“Mucous membrane disease is strongly associated with poorly controlled diabetes and it is prevalent. [diabetes] in India.”

In patients recovering from Covid-19, according to the latest research that studies cases around the world, 94% of people with fungal infections also suffer from diabetes.

And the majority of reported cases of black fungus (71%) came from India.

Is there a link to diabetes in other countries?

In the leading countries with a high prevalence of per capita diabetes, others (other than India) have reported cases of mucormycosis.

Bar chart showing the major countries of diabetes per capita.

Bar chart showing the major countries of diabetes per capita.

Neighbors India, Pakistan and Bangladesh both have high prevalence of diabetes in their populations. And there are cases of mucosal disease – but not particularly many.

In Bangladesh, doctors have treated one patient with confirmed mucositis. and is awaiting test results for another suspect.

Doctors told the BBC that both patients also had diabetes.

Pakistan has also reported five cases of mucositis in recent weeks and four died on May 12, according to media reports.

Brazil has 29 confirmed cases, but it is unclear how many COVID and/or diabetes are there.

Russia has also reported recently “isolated” cases of mucormycosis in coronavirus patients, but it is unclear how many cases have been detected so far.

The United States has a very high prevalence of diabetes – 9.3% of the population is estimated to have the condition.

The most people infected with coronavirus in the world

But mucosal disease is extremely rare – most cases of diabetes are manageable, with only 3% of them going undiagnosed. According to the US Centers for Disease Control

Why might diabetes be a risk factor?

Experts say diabetics are not recorded as much as the level of undiagnosed diabetes that is problematic.

Table % age of undiagnosed diabetes worldwide

Table % age of undiagnosed diabetes worldwide

The IDF estimates that approximately 57% of diabetes cases in India, Nepal, Bangladesh, Sri Lanka are undiagnosed. and almost all of them are found in India.

Pakistan is also estimated to have a high proportion of undiagnosed diabetes.

“There are a lot of uncontrolled diabetes in India because people don’t have regular check-ups,” said Dr Hariprasath Prakash of the International Medical School in Kyrgyzstan.

He said that most diabetics “Detected by other health complications” and have not been treated.

Poorly controlled diabetes puts you at risk for certain infections. including some types of fungi

The African region also has a high proportion of undiagnosed diabetes at nearly 60%, but estimates show that the incidence of mucositis is low – just 3%.

Dr. Denning pointed out that “Maybe because [mucormycosis] Cases may not be diagnosed… It’s not easy to diagnose.”

According to studies, cases of black fungus are not diagnosed due to difficulty in collecting tissue samples and lack of diagnostic sensitivity.

What else can cause black mold?

Experts also suggest that arbitrary use of steroids to treat certain types of coronavirus may be linked to mucosal disease or other fungal infections.

Two of the most widely used steroids are dexamethasone and methylprednisolone. It is used for COVID patients in India to reduce inflammation caused by the body’s immune response.

black mold display

black mold display

However, with more and more hospitals and doctors having more patients. There is evidence that these steroids have been used without medical supervision.

Indian authorities have recently warned This is about self-medication. This could have serious negative consequences, including Dr Denning, such as an increased risk of developing mucosal.

A British trial of approximately 2,000 COVID-19 patients found that dexamethasone Reduces mortality in people with moderate or severe infections. But it can be dangerous for people with mild infections.

The study demonstrated the effectiveness of steroids when used in hospitals. However, it is reported that some states in India have distributed dexamethasone to the public along with home isolation kits.

“It is clear that (Based on studies) steroids don’t improve,” says Dr. Denning.

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