Mucormycosis or Black Fungus Infection - All You Need To Know

COVID-19 Diaries (Part 16): Black Fungus Infection – All You Need To Know

covid19 second wave india
Contributed by: Rachana Arya

 

Amid the onslaught of the second wave of Covid-19 in India, cases of deadly fungal infection- mucormycosis are on the rise. 

 

What is it?

Mucormycosis is a type of fungal infection. Colloquially known as the black fungus, it is relatively rare, but also very serious, if left untreated. The infection is caused by a group of moulds known as mucormycetes, which are present naturally in the environment. 

This fungal infection is very aggressive and presents itself as either a respiratory or a skin infection. The fungal spores commonly enter the body by being inhaled into the sinuses and airways. They can also enter through an open wound or scrapes in the skin.  Once in the body, the fungus can grow rapidly and release large numbers of spores that quickly turn fatal. Mucormycosis cannot spread between people or between animals.

 

Warning Signs and Symptoms

 

Mucormycosis — previously called zygomycosis — is not a new infection. This fungal infection came to the spotlight during the first ‘wave’ of the pandemic when it caused many patients to lose their eyesight. During that Covid period, the Centers for Disease Control and Prevention (CDC) had said, “These fungi aren’t harmful to most people. However, for people who have weakened immune systems, breathing in mucormycosis spores can cause an infection in the lungs or sinuses which can spread to other parts of the body,” Recent guidelines prepared by the Union Health Ministry and ICMR regarding symptoms of Mucormycosis include:

 

  • Pain and redness around eyes and/or nose
  • Fever
  • Headache
  • Coughing
  • Shortness of breath
  • Bloody vomits
  • Altered mental status

 

When to Suspect (in COVID-19 patients, diabetics, or immunosuppressed individuals)

 

  • Sinusitis–nasal blockage or congestion, nasal discharge (blackish/bloody, local pain on the cheekbone, one-sided facial pain, numbness or swelling
  • Blackish discoloration over the bridge of nose/palate
  • Toothache, loosening of teeth, jaw involvement
  • Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
  • Chest pain, pleural effusion, hemoptysis, worsening of respiratory symptoms

You should immediately see a doctor if you are experiencing the above symptoms post the COVID recovery for a definitive diagnosis.

 

Predisposition

Black Fungus does not affect everyone. It typically poses no serious threat to patients with a healthy immune system, which can effectively fight environmental pathogens. However, if the body’s immune system is weak, the fungus may develop and cause serious harm.

Most common underlying diseases that both pre-disposes to the infection and influences the clinical presentation include people who:

 

  • Have pre-existing health problems especially uncontrolled diabetes
  • Have weakened immunity from an illness 
  • Have long-term ICU stay
  • Have co-morbidities – post-transplant/malignancy
  • Have undergone Voriconazole therapy
  • Consume medicines that lower the body’s ability to fight germs and sickness. 

 

covid19 black fungus management

 

Government Advisory to prevent this deadly disease

Dos

  • Control hyperglycemia
  • Monitor blood glucose level post-COVID-19 discharge and also in diabetics
  • Use steroid judiciously – correct timing, correct dose, and duration
  • Use clean, sterile water for humidifiers during oxygen therapy
  • Use antibiotics/antifungals judiciously

 

Don’ts

  • Do not miss warning signs and symptoms
  • Do not consider all the cases with a blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
  • Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDI-TOF), for detecting fungal etiology
  • Do not lose crucial time to initiate treatment 

 

Preventive Measures

  • Use face masks if you are visiting dusty construction sites
  • Wear shoes, long trousers, long sleeve shirts, and gloves while handling soil (gardening), moss, or manure
  • Maintain personal hygiene, including a thorough scrub bath in order to reduce the chances of developing a skin infection

 

Management Techniques

 

  • Control diabetes and diabetic ketoacidosis
  • Reduce steroids (if the patient is still on) with the aim to discontinue rapidly
  • Discontinue immunomodulation drugs
  • No antifungal prophylaxis needed
  • Extensive Surgical Debridement – to remove all necrotic material

 

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