On the night of May 3 at least 23 people were killed, including children
On the night of May 3 at least 23 people were killed, including children
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There are concerning reports emerging from India that an aggressive flesh-eating “black fungal” infection is maiming Covid-19 patients and survivors, attacking their noses, eyes and sometimes brains. Doctors have warned that the rare condition, called mucormycosis, has been detected far more frequently than usual in hospitals across the country, with some fears that it is linked to Covid-19 treatments. So what’s going on? Is the infection really a face eating fungus? Yes. Mucormycosis, colloquially known as the “black fungus”, is a fast-moving infection that attacks a person’s sinuses, lungs and brain. While there are antifungal treatments that can be used to treat the condition, they often don’t work, and poor diagnosis means it is often detected after the fungus has spread. In many cases, patients need surgery to cut out the affected tissue before it spreads to the brain - leading to the loss of their upper jaw and sometimes even an eye. “The fungus grows incredibly fast,” says David Denning, a professor of infectious diseases at the University of Manchester and chief executive of the Global Action Fund for Fungal Infections (Gaffi). “Once it gets in, it just marches through the tissue and doesn’t respect tissue planes, so it can go straight from ordinary tissue through into bone, into nerves.” He adds that the mortality rate is, typically, around 50 per cent - but it can be as high as 80 per cent if diagnosed late. So it’s not a bacteria or a virus? No. Mucormycosis is a third class of pathogen, a fungal infection. It’s caused by exposure to the mucor mould, which is commonly found in soil and decaying organic matter, including plants, compost and fruit. A person can get sick if they breathe in these fungal spores, but it’s thought it isn’t possible to catch mucormycosis from another infected person. Symptoms include a bleeding nose, swelling and pain in the eye, drooping eyelids and blurred or lost vision. Black patches of skin can also emerge around the nose. “All fungi affect different parts of the body and can be slow or fast growing, can be relatively easy to treat, or can be very resistant,” says Dr Elizabeth Ballou, lecturer in Cellular Microbiology at the University of Birmingham. “Mucormycosis is one of the most feared because it grows very quickly and is very difficult to treat.” So how serious is the threat of mucormycosis? The condition is very rare and tends to affect those who have diabetes or are severely immunocompromised – such as cancer patients or people living with HIV/Aids. Usually the condition does not pose a major threat to healthy individuals. Even before the pandemic, India had a far higher baseline of infections than other regions. Experts estimate that the vast country reported roughly 17 cases per million people each year, compared to between two and 10 cases in Britain or France. This is largely because India has a large population living with diabetes, almost 80 million people, who are at risk of severe mucormycosis. Exposure to the mucor mould is also relatively high, says Prof Denning, as it's a dusty environment with a lot of material spreading in the air. But why has India seen a surge in cases? The current increase is thought to be linked to the country’s devastating coronavirus surge, as the steroids used to treat severe Covid-19 – including dexamethasone – dampen the immune response, which can go into overdrive and attack itself in response to the viral infection. Some experts also say that, as hospitals are overwhelmed, many families are self-medicating and may be overusing steroids. And a large proportion of those sick with the “black fungus” have diabetes, as mucormycosis “attacks people with uncontrolled sugar”, says Dr VK Paul, a member of NITI Aayog, an Indian Government think tank. Diabetes is harder to control when a patient is unwell, regardless of the disease. But the steroids used to tackle Covid also push up blood sugar levels. “I think you’ve got a triple effect,” says Prof Denning. “Essentially there’s already lots of exposure, plus [high rates of] poorly controlled or out of control diabetes, and then add steroids to treat severe Covid-19 into the mix.” So how many cases have been reported in India? It’s not entirely clear, as reports are trickling out from individual hospitals. Dr Paul has said that “there is not a big outbreak of it”, but the picture emerging is clear: cases are far higher than usual. For instance in Mumbai, the Sion Hospital has reported 24 cases of the fungal infection in the past two months, up from six cases a year, according to Dr Renuka Bradoo, head of the hospital's ear, nose and throat wing. She told the BBC that 11 patients had to lose an eye, while six died. Are there cases in the UK? Yes. Limited numbers of cases have been reported in countries including the UK, France, Austria, US, Iran, Mexico and Brazil, Prof Denning says. What about other fungal infections? Are they a risk here? Yes. There is a huge range of fungal infections, including many that aren’t life threatening – including thrush, athletes foot and dandruff. But, worldwide, roughly two million people are estimated to die from serious fungal infections every year. Though many have underlying health conditions which weaken their immune response – including leukemia or HIV/Aids – experts say a large proportion of these deaths are avoidable. “We think two thirds of those are preventable if we just had all the diagnostics, and all the medicines that are listed by the WHO is essential,” says Prof Denning. “If they were available to everybody, combined with good clinical education, we think 1.6 million lives could be saved every year.” Some of the nastiest fungal infections include aspergillosis, which affects the lungs and causes breathing difficulties – impacting more than 4,000 people in the UK every year – and cryptococcal meningitis, a serious infection of the brain and spinal column that affects those living with HIV/Aids, leading to roughly 200,000 fatalities a year. But what’s really worrying experts is the growing threat of multi-drug resistant fungal infections, such as Candida auris, an emerging threat which caused an outbreak at the Royal Brompton Hospital in London in 2015 and has now been detected across the globe. The fungi causes a yeast infection, but can also trigger bloodstream infections that are lethal 45 per cent of the time, and most existing antifungal drugs are ineffective treatments. Is it possible that a fungi could trigger a new pandemic? Fungal infections have proved devastating for frogs and plants in the past. For instance chytrid fungus, which eats away at the skin of amphibians, has been linked to the decline of 500 species in the past 50 years – including 90 extinctions. Meanwhile fungi like ash dieback, chestnut blight and Japanese larch disease, have wiped out thousands of trees. But experts say they are less likely to trigger a pandemic, as fungi rarely jump from person to person. “Let’s put it like this: I don't think we're going to see the end of the human population because of fungal infections,” says Prof Denning. Instead, experts warn about a slow moving crisis of increasingly untreatable infections. “Fungal infections are a growing problem that has definitely been underestimated, but not because they’re going to suddenly spread person to person like Covid-19,” says Dr Ballou, warning that drug resistant infections will instead “creep up on us.” Protect yourself and your family by learning more about Global Health Security
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A black fungus with a mortality rate of 50 per cent is increasingly infecting recovered Covid-19 patients in India, with doctors forced to remove parts of the face of some sufferers to save lives. Mucormycosis, caused by a mucor mould commonly found in soils and decaying vegetables, infects the sinuses, the brain, and the lungs of immuno-compromised people. Prior to the coronavirus pandemic, mucormycosis was extremely rare, with just a few cases annually. But, leading hospitals across India are now seeing multiple cases daily. If it is feared that the mucor will spread to the brain then invasive surgery is a last-ditch recourse, with Indian doctors being forced to remove the infected jaw bone, nose, and eyes of patients. “The situation here has improved in terms of numbers of Covid-19 patients requiring admission but mucormycosis is now playing absolute havoc,” said Dr Prashant Rahate, the Chairman of SevenStar Hospital in the city of Nagpur, which has treated more black fungus patients than any other facility in central India.
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What is the deadly ‘black fungus’ seen in Covid patients in India?. Usually very rare, mucormycosis has a high mortality rate and is difficult to treat
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Detectives investigating the death of PCSO Julia James have staged a reconstruction of her final walk featuring her loyal canine companion, Toby, the Jack Russell. Exactly two weeks on from the discovery of her body in woodland in Kent, an actress, wearing the same outfit as the 53-year-old, retraced her steps as she went on her final dog walk. She set off from Mrs James’s home in Snowdown for the 30-minute walk to the perimeter of Ackholt Woods, where her body was found on Tuesday 27 April. Dressed in a turquoise waterproof Berghaus jacket and navy tight-fitting jeans tucked into black boots, the blonde middle-aged actress known only as Sue, led Toby on a neon yellow lead through the fields behind Julia’s home towards the woods. The journey Mrs James took would have seen her leave her house through the back garden gate and turn right onto a weed-covered footpath, bordered by thick woodland on either side. After around a minute and a half of walking, she exited the woodland into a large farmer’s field, bordered on the far right side by Aylesham Road and on the far left side, Ackholt Woods. The actress then headed through the field in the direction of Aylesham, keeping to the perimeter hedgerow which runs along Aylesham Road. Heading in the same direction, she then slipped through an opening in a hedgerow separating two fields before turning left and following a bridleway along the foliage border between the fields in the direction of Ackholt Woods. The reconstruction ended a couple of metres away from a rectangular area sealed off with police tape at the edge of Ackholt Woods, where Mrs James’s body was discovered by members of the public. It was a regular walk she took with her pet dog and police said they hoped that by reconstructing the journey more potential witnesses might be encouraged to come forward with information about the case. The reconstruction took place just a short time after a 21-year-old local man, Callum Wheeler, appeared in court charged with the murder of Mrs James. He made a brief appearance at Medway Magistrates’ Court and was remanded in custody to appear before Maidstone Crown Court on Thursday. Assistant Chief Constable, Tom Richards, who is leading the investigation, said he still wanted anyone who had been in the area at the time to come forward as they might have vital information. He said: "Today I continue to appeal for witnesses. I’m confident that there were people in the area at the time who we are keen to speak to. "We have an obligation to piece together what happened in the last moments of Julia’s life. The actress will be wearing clothing identical to the clothing worn by Julia that day. Her walk took approximately 30 to 40 minutes." He added: "Once again I appeal to anyone who remembers anything at all to help us piece together the last vital pieces. "What we will see today is the actress and Toby leaving the area of her home address and entering the pathway, then exiting that pathway on to the edge of a field. "We will see her conclude her walk and enter the woodland where she was found. "We want to make this as realistic and authentic for the public as possible." He added: "We still have accounts of people in the woods and fields of that area who we don’t think we’ve identified. "I still think there were people enjoying the beautiful countryside in that area and I appeal for people to come forward. We have had special support from local residents. "It’s possible that someone just passing through is aware of those events."
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