A 49-year-old COVID positive woman admitted at Delhi's Ganga Ram Hospital has developed multiple holes (perforations) in her oesophagus (food pipe) and intestine due to the White Fungus disease. Doctors believe this could be a reaction to her recent history of breast cancer, chemotherapy, and an intense COVID-19 infection.
Gastroenterologists treating the patient said that such a phenomenon has never occurred before and that they have even sought the assistance of doctors from Boston to understand the implications of this never-seen-before effects of the disease. White fungus caused by Candida does tend to affect the mouth or oral cavity, vagina, or gut. It is considered to be one of the most common fungal infections, according to experts.
Dr. (Prof.) Anil Arora, Chairman, Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, stated that there is no literature suggesting the role of Candidiasis in affecting the intestine.
So far, there have been reports of increase in the cases of Mucormycosis- the black fungus along with reports of white fungus being more dangerous than the black fungus. BOOM had spoken to experts regarding the claims who stated that since a lot is known about Candidiasis, it is easier to tackle.
BOOM spoke to Dr. Samiran Nundy, Advisor, Department of Surgical Gastroenterology & Liver Transplantation, Sir Ganga Ram Hospital about the severity. "As there are more reports of mucormycosis currently and not enough to show that candidiasis can affect organs like the intestine and liver, it is too early to say if it could be more dangerous. Currently, the fungal infection is milder than black fungus. However, with the nature of COVID-19, anything could be possible"
What Did Doctors At Sir Ganga Ram Observe In The Patient?
The 49-year-old woman who had recently undergone a mastectomy (removal of breasts) to treat her breast cancer got admitted to the hospital on May 13 after she complained of severe abdominal pain, vomiting and constipation was in respiratory stress. She was receiving chemotherapy till April 13, 2021.
"A CT scan of the stomach showed that she had presence of fluid in her abdominal cavity suggesting perforations. We immediately placed a tube inside the abdomen and drained about one liter of bile-stained pus," explained Dr, Arora.
Dr. Nundy undertook an immediate surgery which revealed that there were multiple perforations in her body. "Surgery revealed perforation in the lower end of the oesophagus (food pipe). A part of the small intestine had developed gangrene and sloughed off and she had multiple thinned out patches in the wall of the colon with one small leak. The perforations were closed and the gangrenous segment was resected in a difficult surgery lasting for 4 hours after which a piece of intestine was sent for Biopsy", he stated.
The biopsy revealed that she had severe invasive candidiasis and that her COVID-19 antibodies had also elevated. She was immediately started on antifungal medications.
Doctors Hypothesise Science Behind Perforations
The woman was already immuno-compromised due to her mastectomy, and chemotherapy, and thus COVID-19 acted as a playground for fungal growth, believe the doctors.
"As the exact mechanism is unknown, the probable explanation involves an unholy combination of three states causing immunosuppression: a malignancy (carcinoma breast), recent chemotherapy, and a superimposed COVID-19 infection. All three factors conspired together in her case bringing down the immune system to dismally low levels resulting in turncoat of a normal inhabitant of intestine called Candida into a monstrous invasive form resulting in multifocal intestinal perforations with resultant shock and septicaemia," explained Dr. Arora.
Dr. Arora further explained how all the three underlying conditions assisted Candida to scourge through the body tissue barriers and infecting the intestine.
"Normally the intestine remains in perfect harmony with the fungus called Candida. In immunosuppressed states like diabetes, injudicious use of steroids, overzealous broad-spectrum antibiotics and chemotherapy for any underlying malignancies, there is inward migration of this Candida - the White Fungus - from the intestinal lumen into the body tissues by disrupting the normal gut barriers. This is followed by intestinal complications like ulcers, bleeding, gangrene and perforation followed by transmigration of the Candida across the beleaguered gut barrier into blood culminating in septicemia and multiorgan failure," concluded Dr. Arora.
