A case in Delhi’s Sir Ganga Ram Hospital suggests that the immunosuppressed state brought about by Covid, along with other factors, may have contributed to aggravation of normally occurring Candida — what is popularly being called White Fungus — from an intestine to an invasive form. This is the first-of-its-kind case of white fungus reported in the world.
On May 13, a 49-year-old woman was admitted to the Sir Ganga Ram Hospital with complaints of severe abdominal pain, constipation and vomiting. Doctors treating her conducted a CT scan which revealed perforations in the lower end of the food pipe. A team of surgeons then conducted an emergency surgery and fixed perforations. The woman, also a cancer patient, was on chemotherapy some time ago.
According to doctors, the CT scan and surgery revealed perforation in the lower part of the oesophagus, gangrene in a part of the small intestine and thinning of multiple patches of the wall of the colon. Biopsy revealed ulceration of the intestinal wall caused by invasive Candida pseuodhyphae. They also stated that her Covid antibody levels were “markedly elevated”.
“The Covid 19 virus has been known to affect the lungs and upper respiratory tract. Infection of the intestine by Mucormycosis secondary to steroid use has been recently reported but Candida causing severe ulceration and gangrene of the intestine presenting with multifocal perforations in esophagus, 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 Anil Arora, Chairman of the Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences at the hospital, said.
Malignancy, recent chemotherapy, and a superimposed COVID-19 infection together drought down the immune system of the patient to dismally low levels, he said.
Normally the intestine remains in perfect harmony with the fungus called candida. In immunosuppressed states such as diabetes, injudicious use of steroids, overzealous broad-spectrum antibiotics and chemotherapy for an underlying malignancy, there is inward migration of this candida – the white fungus – from the intestinal lumen into the body tissues by disrupting the normal gut barriers.