While diseases such as tuberculosis and HIV are at the forefront of media attention regarding infectious disease, one threat has long gone overlooked – fungal disease.
A recent study that brought together expertise from three Indian teaching hospitals: AIIMS New Delhi, AIIMS Kalyani, West Bengal and PGIMER Chandigarh along with The University of Manchester. Together they reviewed over 400 published academic articles and compiled the data to present a more clear picture of the risks posed by fungal disease in India.
Dr Animesh Ray of AIIMS in Delhi, the lead author of the article, noted that “the total burden due to fungal diseases is huge but underappreciated…While tuberculosis affects less than three million people in a year in India, the number of Indians affected by fungal disease are several times higher.” Their study estimates that 57 million people in India are impacted by fungal disease.
Vaginal thrush – or yeast infection – was found to impact around 24 million women of reproductive age. Many of these women suffered from repeated episodes of the disease. Another disease, hair fungal infection – or tinea capitis – was documented in studies conducted in Kolkata. It was found that ten percent of all urban primary school children in Kolkata were affected by the condition. The data suggests that, when extrapolated to the whole country, tinea capitis impacts roughly 25 million individuals. Among all tinea capitis cases, children represent ninety percent of cases, with seventy percent of cases occurring in lower-income groups.
The study noted a major shortcoming when it came to mortality data, which it cites as being difficult to establish for the whole country due to significant absences in the available data. A number of conditions with high mortality rates were documented, with a considerable number of affected individuals – likely indicating a significant mortality rate associated with fungal disease. Mould infections affecting lungs and sinuses were reported in over 250,000 people, while 1,738,400 people had chronic aspergillosis and a further 3.5 million had serious allergic lung mould disease.
Roughly 200,000 were reported with mucormycosis – or black mould – a disease that hit headlines during the COVID-19 pandemic. During an initial report of the outbreak of the condition India accounted for 71 percent of all mucormycosis cases across the globe. It was originally speculated that the use of steroid treatment for those with COVID-19 – itself reducing immune response – had allowed mucormycosis to spread to the lungs and cause severe infections. This often resulted in the death of the individual, being more severe due to a comorbidity with COVID-19.
Upon further investigation, cow dung came under the spotlight as a causative factor, with those states commonly using the dung during religious, or Ayurvedic practices showing notably higher rates of the condition than those that didn’t. The mucor mould that causes the disease is commonly found in manure, and burning the manure during religious practice can cause a release of the mould into the air.
Instances such as this highlight a particular vulnerability to fungal disease. With a large subsection of the population working in agriculture, often closely with animals, many are particularly prone to contracting these diseases. Notably, this means that those at most risk often find themselves in areas least able to avail adequate healthcare.
“There have been major diagnostic improvements in recent years, with public health services in India catching up with private hospitals in terms of capability.” said Professor David Denning of The University of Manchester and Global Action For Fungal Disease. “However, fungal disease continues to be a threat to public health and a cause of significant morbidity and mortality representing a considerable socioeconomic burden to those who are infected by them”
The prevalence of these diseases is a major cause for concern. However, the fact that mortality rates are not established is perhaps more concerning still. More data needs to be gathered on the issue. It is without a doubt that fungal disease is a major threat to public health in India, and, without proper data, any efforts to address the issue will be inadequate.