Mumbai: Covid-19 negative woman dies of black fungus despite right surgery

lsquoMujhe ghar le chalo bachon ke pass take me home I want to be with the kidsrdquo said Mohsina Khatoon as she was being taken to Lucknow airport to board a flight for Mumbai on May 11 She raised hopes of everyone with signs of recovery from severe mucormycosis infection only to suddenly sink and die a week later The death of the 43yearold belies the common belief that the fungus attacks those who have had a brush with Covid19Khatoon was diagnosed with lsquoIntra Cerebral Extension of Mucormycosis with orbit maxilla and palat involvementrsquo requiring major surgeryHer family says doctors in Lucknow were concerned about her postoperative care They airlifted her to MumbaiAt Sushrut Hospital Chembur a team of 12 surgeons began operating on Khatoon at 7 pm the same day and it went past midnight till 2 am The mucar had penetrated deep into her skin bone and blood vessels Her right eye had to be removed and the right side of orbit maxilla and palat were separated Her Covid19 tests were negativeAlso Read Black fungus found in brains of many patients in Indore hospitalKhatoon showed good response and her husband Mohammed Akaram 46 and nephew Wasim Khan 22 were amazed to see her taking a stroll inside the ward on the sixth dayldquoShe had lost her right eye and a part of the face but we were pleased that she was alive However on May 18 her sugar level dropped to 49 Doctors found that she had developed a brain haemorrhage at a nonoperated part of small brain area She passed away the following dayrdquo Wasim told middayNo Covid19 case in villageWasim said Khatoonrsquos village has a population of 2300 and they have no case of Covid19 so far The mother of four would help her husband in farmingKhatoon got a mild fever on April 26 and vomited nonstop Her sugar level shot up to 600 mgdL Doctors at Globe Medicare hospital in Lucknow brought her sugar levels to 200 and began treating her for mucormycosis ldquoThey continued to treat my aunt until they advised to give up on her saying medicines were not able to stop the spread of the fungusrdquo said Wasim Their relatives in Mumbai then contacted Dr Prashant Kewle at Sushrut HospitalldquoWe had never heard of this fungal ailment We should have got her to Mumbai earlier The family and relatives who financially supported her treatment are in shock We airlifted her body on May 19 and buried her at the villagerdquo said WasimDr Shashank Joshi consulting neurosurgeon who operated on Khatoon said ldquoThe fungus involving the brain is a rare condition which specifically affects diabetic and low immunity patients Most of the time the medical line of treatment can take care of unless it causes a stroke In that situation either through the nose or sometimes even the skull needs to be opened to get rid of the fungusrdquoDr Joshi said they have had many cases before Covid19 ldquoBut now we are seeing more of these patients and they need surgical removal of the affected portionrdquoThe expert said the initial step involves the removal of damaged tissues since the fungus causes inflammation and obstructs blood flow to areas near facial bones including sinuses and cheek ldquoSo there is no other way out but to remove the diseased part This is lifesaving as antifungal medicines cannot reach the diseased tissue due to blockade of blood vesselsrdquoldquoWhenever brain is affected then neurosurgeon amongst the team is the key person to decide the extent of surgical excisionrdquo added Dr JoshiDr Kewle HOD ENT Anterior Skull base surgeon said ldquoWe were hopeful that we would be able to save her and she had responded well to the initial surgery wherein mucormycosis extensive debridement was done The second part of surgery would have involved reconstruction of defectfree flap but unfortunately she developed a small haemorrhage in small brain which was not affected by the mucormycosis and she breathed her lastrdquo He said the hospital helped the family with concessions and fundraisingDr Kewle said ldquoHer untreated diabetes might be the core reason for her getting infected by mucormycosisrdquoDr Kewle said endoscopy can detect the fungal infection and early surgery can be beneficial ldquoIf vision is lost eyeball preservation is of no use and it may add to the further requirement of surgery and more antifungal injection Optimal and radical surgery should be planned as per MRI findings We need to conduct extensive research as the myth that mucormycosis only affects patients who have recovered the second wave of Covid19 is debatable especially after the Kahtoon incidentrdquoAttempts to contact Dr Deepak Aggarwal Gastroenterologist who runs Globe Medicare hospital Lucknow did not yield any result