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

While the whole world is under attack of a second wave and more severe potent mutant form SARS CoV-2 virus causing SEVERE COVID 19 PNEUMONIA pandemic ,a new disease on verge getting declared as an epidemic named MUCORMYCOSIS OR BLACK FUNGUS (in common term). umbrella term used for opportunistic infection caused by several fungi belong to GLOMEROMYCOTAFAMILY(mucor, zygomucor,lichtheimia,syncephalastrumetc) these saprophytic can be found in soil,food damped walled environment which were actually considered non pathogenic organism human. In current days it has become emerging especially india. Now ASSOCIATED raised threat fear india during CORONAVIRUS INFECTION.Due irrational use drug PREDNISOLON DEXAMETHSONE(which basically steroid group drugs) management AQUIRED PNEUMONIAMOR,ESPECIALLY FOR THOSE WHO ARE ON HIGH O2 REQUIREMENT raise 2 issuesone improper glycemic control,second immunosupressant stage HERE IS A CASE REPORT THAT CAN PROVE CASES OF WERE INEVIDENTLY PRESENT IN INDIA EVEN BEFORE THIS PANDEMIC STARTED. 40 years old male,a cotton mill worker ,was admitted emergency observation ward IPGME&R AND SSKM HOSPITAL,KOLKATA AROUND THE MONTH OCTOBER 2018 with random blood glucose level(RBS) 702 gm/dl along history necrotic oral ulcer over hard pallete extending posteriorly left sided nasal blockage complaint difficulty eat swallow both liquid solid rhinolalia since 45 days. There was no fever,cough,haemoptysis,no trauma affected site or tuberculosis. At this point high RBS elevated urea creatinin level patient diagnosed diabetic ketoacidosis he managed iv. Insuline hence forth his kept control insulin therapy. taking came into our notice that known case type diabetes mellitus CKD-STAGE V due IgA Nephropathy receiving Prednisolon suddenly discontinued 15 before admission also underwent haemodialysis twice. On local examination had palate debris cavity(as evident endoscopy).CT —nose+PNS showed maxi antrum opacity suggestive pansinusitis . All broad spectrum antibiotics iv voriconazol started immune compromised. After though orbital involvement visual impairement eye.A repeat CT progression sinusoidal toward retro space bulky oedematous inferior rectus inflammation then refered microbiology department suspection mucormicosis?.scrapping material collected from ulceration KOH mount done ? aseptate hyphae acute angle branching? Suggestive mucormicosis culture SDA SDCA media. Culture growth revealed abundant, erected mycelium(around 0.5cm tall) .the surface colour colony at first white yellow,after few centre tured black?.Lactophenol blue(LPCB) stain wide ribbon like sporangiophores terminated swollen vesicles radial merosporangiae spores confirmed diagnosis Rhino zygomycosis Syncephalastrum racemosum made. The put intensive short acting achieve optimum control.As there risk vascular invasion mucormicosis(which most mode pathogenecity fungi) leading sudden stroke following ischemia surgical debridement infected tissue removed. He intravenous liposomal Amphotricine B 300mg daily OD later shifted take voriconazole 200 BD.the got discharged favourable condition. literature shows Fluconazole, voriconazole, itraconazole do not have reliable activity against mucormycosis.DRUGS CHOICE should Liposomal amphotericin, Amphotericin lipid complex, Posaconazole, Echinocandins, Deferasirox. recent senario many positive patients are advices tele medicine vedio consultation self medicating themseleves learning various social media india.Now drugs prednisolon out proper monitoring discontinuation once feeling better giving rise absolute lack circulating neutrophils either pulmonary ,or rhinocerebral rhino mucormycosis those even after recovering INFECTION.The HRCT CHEST very difficult differentiate ground glass formed lungs So unsupervised intake steroids prolonged antifungals increasing rate fatality.