WHITE FUNGUS: Have the knowledge, not the fear

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Dr Vivek Dave

If diagnosed and treated in time, it is unlikely to cause any risk to life or vision

“Based on our experience, the cases of white fungus are currently rare, and hence we don’t need to panic. But we need to be watchful of the symptoms and take timely treatment. If diagnosed and treated in time, it is unlikely to cause any risk to one’s life or vision,” says Dr Vivek Pravin Dave, Retina Specialist, L V Prasad Eye Institute

In a nutshell 

  • It affects the retina in the eye and can lead to vision loss 
  • Symptoms include seeing a black shadow or floaters in front of the eye with variable degrees of vision loss
  • The eye can be mildly red with minimal pain
  • It can occur either concurrent to the COVID-19 infection or in the early post-recovery phase
  • Patients with co-morbidities, poorly controlled diabetes, and on long-term steroids and indwelling IV (intravenous) are more at risk
  • Treatment for the eye involves intraocular surgery and intraocular injections
  • Unlike Mucormycosis (Black Fungus), the effect of the white fungus is largely known to be restricted within the eyeball and does not need any facial and sinus surgery

What is White Fungus? 

The scientific term for it is Candida albicans. It is a kind of yeast that naturally lives in and on our body, but an overgrowth can lead to health problems. The yeast appears white when cultured in a laboratory, and hence this fungal infection is called ‘White Fungus’. It can affect various parts of the eyeball. It can also affect any part of the body.

How is it different from Mucormycosis (Black Fungus)? 

Mucormycosis predominantly affects tissues around the eyes, especially nasal sinuses, while the white fungus affects mainly tissues inside the eye, especially the vitreous gel and the retina.

Is White Fungus as life and vision-threatening as Mucormycosis? 

If untreated, it can lead to significant vision loss. It is life-threatening only if the infection spreads to the whole body. That also happens only in patients who are severely debilitated and immunocompromised. There isn’t adequate data to compare white fungus versus black fungus in COVID recovery patients, as cases due to the white fungus are currently very rare. 

What are the symptoms? 

  • Decrease in vision within 1-3 months of COVID recovery
  • Vision loss is often central vision loss
  • Seeing a black shadow or lots of black floating particles/floaters in front of the eye

Why is it caused? 

The current COVID management protocols require judicious but high dose steroid usage in those patients whose lungs have got affected. While it helps bring down the COVID-related damage, the counter-effect is that it suppresses the body’s immune mechanisms, making it more vulnerable to these kinds of fungal infections. 

Who are at risk of developing White Fungus? 

Patients who have low immunity or high blood sugar levels are more at risk. In the context of COVID-19 infection, it can occur either concurrent to the COVID-19 infection or in the early post-recovery phase (within 6-8 weeks after developing the first fever) as the immune system is low on that timeline. Patients with co-morbidities like diabetes, systemic immunosuppression (low immunity) or any other major systemic disease (chronic disorder) are more likely to have this infection. It is also being observed in patients who have been treated with steroids for COVID-19 infection as steroids suppress the immune system and also raise blood sugar levels. 

What is the treatment? 

The treatment comprises intraocular surgery, antifungal injections within the eye and oral antifungal agents. Often the surgical procedures need to be repeated, and the entire treatment can extend to over 4-6 weeks. Controlling blood sugar and improving the immunity status of the patient is very important.

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