In recent years, fungal infections have been on the rise. This trend is expected to persist, driven by several factors including rising temperatures creating favourable conditions for fungal growth and spread, besides the misuse of over-the-counter drugs and ointments among others. ARCHANA JYOTI highlights its widespread impact through various studies.

Sachi, a 45-year-old housewife, has been experiencing discomfort and embarrassment due to a persistent fungal nail infection which started with discoloration and thickening of the nails on her right foot, gradually spreading to the other foot. Over time, her nails became brittle and began to emit a foul odor. Sachi, also experienced occasional itching and pain around the infected nails.

The fungal infection has made it difficult for the mother of two to wear open-toed sandals during warmer months, affecting her confidence, particularly in social settings where she felt judged for the appearance of her nails.. Initially, she tried over-the-counter antifungal creams and ointments, but they provided only temporary relief. After consulting a dermatologist, she was prescribed oral antifungal medications along with topical treatments for the infection called ‘Athelete’s Foot’. However, despite adhering to the treatment regimen diligently, progress was slow, and complete eradication of the infection seemed elusive.

Dealing with a chronic fungal infection is taking a toll on her mental health besides financial strain. But Sachi’s case is not the only one in the country; milions are battling with this fast emerging menace.

A recent study conducted by experts from Indian teaching hospitals and The University of Manchester says over fifty million individuals in India are affected by serious fungal diseases, with approximately 10 per cent facing potentially dangerous mould infections.

The study, published in the journal Open Forum Infectious Diseases, presents an estimate that approximately 4.4 per cent of India's population, which equates to around 57 million people, are likely impacted by these fungal conditions. The research draws from an analysis of data from over 400 published academic articles.

Key findings from the study:

Prevalence among Women: Vaginal thrush, or yeast infection, affects around 24 million women of reproductive age, with recurrent episodes being common.

Impact on Children: Hair fungal infections, known as tinea capitis, affect a similar number ie 24 million  school-age children. This condition can cause painful infected scalps and often results in hair loss.

Mortality Contributors: Mould infections affecting the lungs and sinuses are identified as major contributors to mortality, affecting over 250,000 individuals.

Chronic Conditions: The study also highlights chronic fungal conditions such as chronic aspergillosis, which affects approximately 1,738,400 individuals, and serious allergic lung mould diseases, impacting around 3.5 million people.

Eye and Skin Infections: Over 1 million individuals are thought to have potentially blinding fungal eye diseases, while nearly 200,000 suffer from mucormycosis, commonly referred to as 'Black mould'.

The global study using data from 80 countries including India has said that the annual total of mortalities from such ailment is now estimated at 3.75 million, a figure that doubles previous estimates, and outnumbers deaths from malaria six-fold and from tuberculosis three-fold.

Dr. Animesh Ray, the lead author of the study and affiliated with AIIMS Delhi, underscores the significance of the findings, stating that the total burden due to fungal diseases is substantial but often underappreciated. He sounds alarm saying that the number of individuals affected by fungal diseases significantly exceeds those impacted by tuberculosis in India.

Candida -- another type of fungal infection -- is becoming a serious problem in intensive care, complex surgical patients, diabetes, cancer and renal failure, as well as premature babies. The researchers estimate that about 1.57 million people suffer from Candida bloodstream infection or invasive candidiasis with 9,95,000 (9.9 lakh) deaths (63.6 per cent), each year.

Co-author of the study, Professor Denning from The University of Manchester and Global Action For Fungal D acknowledges the progress made in diagnostic capabilities. However, he emphasizes that fungal diseases continue to pose a significant threat to public health, leading to considerable morbidity and mortality. He also notes the existence of large parts of India with limited diagnostic capabilities, which underscores the need for further improvements in this regard.

The study concludes that addressing the challenge of fungal diseases in India requires continued efforts to enhance diagnostics, raise awareness, and implement effective strategies to mitigate the socioeconomic impact of these diseases on affected individuals and communities.

Dr. Ravinder Singh Chauhan, MS (ENT) Director, Delhi Center for ENT & Allergic Diseases sheds light on fungal infection of the oral cavity.

“Candidiasis (also known as oral thrush) is one of the most common fungal infections of the mouth (oral cavity). It is generally seen in patients with poor oral hygiene, uncontrolled diabetes, those taking steroids for long durations for other diseases, or suffering from other immunocompromising diseases.”

On symptoms, he said, patients suffering from candidiasis develop white patches in the mouth or on the tongue and back of the throat. It is easily treatable if diagnosed early. If anyone has the above symptoms, they should visit an ENT specialist, said Dr Chauhan.

“Patients suffering from diabetes should keep their blood sugar under control and maintain oral and dental hygiene.”

Experts say, climate change is also contributing to the rise of fungal infections. As temperatures rise, fungi are able to thrive in new environments and infect new hosts. In addition, extreme weather events such as hurricanes and floods can create conditions that are ideal for fungal growth and spread.

Take the case of Athlete's Foot, caused by the fungus Trichophyton. It typically manifests as itchy, red, and cracked skin between the toes and on the soles of the feet, says Dr Richa Chaudhary, Consultant Dermatologist, Skin & Hair by Dr Gangwani Clinic, Paschim Vihar, Delhi.

"Superficial fungal infections, often affecting the skin, hair, and nails, are common yet manageable dermatological conditions. "Athlete's foot is a prevalent and contagious condition, scientifically termed tinea pedis, primarily targets the feet. It thrives in warm and damp environments such as locker rooms, swimming pools, and common showers.

"The hallmark symptoms of athlete's foot encompass itching, burning sensations, and the development of red, scaly patches between the toes or on the soles. In severe cases, there can be cracking of skin or appearance of itchy pus-filled blisters, delay in the healing of the cracked skin leading to discomfort and pain. The infection can also spread to the toenails, causing thickening and discoloration.

"Maintaining proper foot hygiene/avoiding shared personal items, such as towels and shoes, regularly changing socks, opting for moisture-wicking materials, and allowing shoes to air out between uses can significantly reduce risk of contracting the fungus,” says the doctor.

In extreme cases, or persistent or severe infection it is essential to seek professional medical advice as prescription strength antifungal medication may be required, she says.

Most common fungal diseases

• Fungal nail infections: Common infections of the fingernails or toenails.
• Vaginal candidiasis: Caused by the yeast Candida, also called a “vaginal yeast infection.”
• Ringworm: A common fungal skin infection that often looks like a circular rash.
• Candida infections of the mouth, throat, and esophagus: Caused by the yeast Candida, also called “thrush”.
• Fungal eye infections: Rare infections that can develop after an eye injury or after eye surgery.
• Sporotrichosis: Caused by the fungus Sporothrix, which lives throughout the world in soil and on plants.
• Mycetoma: Caused by certain types of bacteria and fungi found in soil and water, typically in rural regions of Africa, Latin America, and Asia.
• Healthcare-Associated Fungal Meningitis: Rare life-threatening fungal infection that causes swelling of the areas around the brain and spinal cord.

Who’s at Risk?

Fungal infections can affect anyone, but certain groups are more vulnerable than others. People with weakened immune systems, such as those undergoing cancer treatment or organ transplant recipients, are particularly susceptible to fungal infections. In addition, people with chronic conditions such as diabetes, HIV, or asthma are also at increased risk.

The elderly are also more likely to develop fungal infections, as are young children and infants. In some cases, fungal infections can spread from person to person, particularly in healthcare settings. Hospital-acquired fungal infections can be particularly dangerous, as these strains of fungi are often resistant to multiple drugs.