Delhi reported its first-ever severe case of white fungus when a 49-year-old girl was admitted to the Sir Ganga Ram Hospital (SGRH) on May 13 with complaints of severe stomach ache, vomiting and constipation.
She had undergone a mastectomy for breast most cancers in December final yr and had acquired chemotherapy until 4 weeks in the past, he mentioned.
“A CT scan of the abdomen revealed free air and moderate amount of free fluid in the abdominal cavity suggestive of an intestinal perforation,” the hospital mentioned in a press release.
The docs instantly positioned a tube contained in the stomach and drained about one litre of bile-stained pus.
A staff of surgeons led by Dr. Samiran Nundy of the Department of Surgical Gastroenterology and Liver Transplantation performed emergency surgical procedure on the affected person the subsequent day.
The surgical procedure revealed perforation within the decrease finish of the meals pipe. Part of the small intestine had developed gangrene and sloughed off, and the affected person had a number of thinned out patches within the wall of the colon with one small leak, Dr. Nundy mentioned.
“The perforations were closed and the gangrenous segment was resected in a difficult surgery lasting four hours after which a piece of intestine was sent for biopsy,” he mentioned.
The biopsy revealed severe ulceration of the intestinal wall with resultant perforation and necrosis attributable to invasive white fungus, Dr. Arora mentioned.
The girl’s Covid antibody ranges have been markedly elevated. Her blood and peritoneal fluid tradition confirmed exuberant development of the fungus. She was instantly began on anti-fungals and confirmed exceptional enchancment, he mentioned.
“White fungus (Candida) causing multifocal perforations in the food pipe, small bowel and large bowel in Covid-19 infection has not been reported in literature to the best of our knowledge,” Dr. Anil Arora, Chairman of the Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences on the hospital, mentioned.
However, 5 days later, she had to endure a second surgical procedure for a small leak from the anastomotic web site. She is at the moment recovering from it, mentioned Dr. Aurobindo of the Department of Liver Transplantation and G I Surgery.
There have been circumstances of fungal an infection (black fungus) secondary to Covid-19 an infection with underlying diabetes, however “white fungus causing severe ulceration and gangrene of the intestine with multifocal perforations in the food pipe, small bowel and large bowel in the setting of Covid-19 infection has not been reported in literature to the best of our knowledge”, Dr Arora mentioned.
Malignancy, latest chemotherapy, and a superimposed Covid-19 an infection collectively drought down the immune system of the affected person to dismally low ranges, he mentioned.
Normally the intestine stays in excellent concord with the fungus referred to as candida. In immunosuppressed states comparable to diabetes, injudicious use of steroids, overzealous broad-spectrum antibiotics and chemotherapy for an underlying malignancy, there’s inward migration of this candida – the white fungus – from the intestinal lumen into the physique tissues by disrupting the conventional intestine limitations.
This is adopted by intestinal problems like ulcers, bleeding, gangrene and perforation, adopted by transmigration of the candida throughout the beleaguered intestine barrier into blood, culminating in sepsis and multiorgan failure, Dr. Arora mentioned.
(With inputs from PTI)