Mucormycosis, commonly known as Black Fungus, is being called an epidemic inside a pandemic with thousands of deaths among COVID patients in India.
What Is Black Fungus?
What are the symptoms, when should one seek treatment, and most important of all, can it be prevented?
With around 2.2 to 3.8 million species, the fungus has a kingdom of its own. It is all around us: in air, water, soil, plants, decaying matter, and even inside us.
They are principal decomposers in ecological systems, found in yeast, molds, and mushrooms we eat, and help ferment wine, beer, and soy sauce. They are also used to produce antibiotics.
However, at least 300 fungus species are pathogenic to humans.
Persons with compromised immunities are particularly susceptible to ‘opportunistic infections’ by fungus genera such as Aspergillus, Candida, Cryptococcus, Histoplasma, and Pneumocystis.
Other fungi attack eyes, nails, hair, and skin to cause ringworm and athlete’s foot.
Sinus and deep lung infections can also be caused by them and entry of fungus into the bloodstream can cause a full-blown infection. Fungal spores can also cause allergies.
Though fungi exist in our bodies, our strong defense mechanisms keep infections at bay. However, the moment our immunities are compromised, fungi cause fatal infections.
Some reasons for reduced immunities are
- Diabetes with high blood sugars and acidic environments providing the required recipe for fungal growth
- Steroid medication that increases blood sugars and reduces immunity
- Blood malignancies
- Immunosuppressant medicine
- Patients with excess iron in their bodies
- Trauma, burns
- Malnutrition
Mucormycosis or black fungus is a rare but serious and aggressive fungal infection caused by moulds known as micromycetes and causes problems when immunocompromised individuals inhale environmental sporangiospores (3-11micron) or if it enters through wounds.
Thus diabetics who have just recovered from COVID are most prone to it.
Mucormycosis Is Mainly Of Six Types
Rhino-orbito-cerebral mucormycosis (ROCM)
This causes nasal stuffiness, foul smell, nasal discharge, pain and redness around eyes and nose, loss of vision, restriction of eye movements, blackish discoloration over nose-bridge, prolonged fever, headache, toothache, loosening of teeth and jaw, and altered mental state.
Cutaneous and soft tissue mucormycosis
This type is marked by distinct black dead tissues at the puncture site and muscle pain.
- Pulmonary mucormycosis
This causes fever on broad-spectrum antibiotics, cough, shortness of breath, and chest pain.
- Gastrointestinal mucormycosis
This results in fever, bleeding through the anus, mass-like lesions, and perforation of the gut.
- Mucormycosis of bones and joints
Results in local pain and tenderness and cellulitis.
- Disseminated mucormycosis
Symptoms of this type can vary as per the site of involvement and is mostly associated with pneumonia.
Those, particularly at risk, are people who’ve had severe COVID-19 in the last six weeks.
Others at risk include diabetics, people with granulomatous diseases, HIV/AIDS patients or those with primary immunodeficiency states, people who use immunosuppressant in the form of steroid - especially those who’ve used it for over three weeks or a high dose for a week, people who use Tocilizumab, other immunomodulators or therapy used with transplantation, prolonged neutropenia, trauma, burns, IV drug abusers, those who’ve had prolonged ICU stay, those with post-transplant/malignancy or use Voriconazole therapy and Deferoxamine or other iron overloading therapy.
Contaminated adhesive bandages, wooden tongue depressors, construction, and hospital linens can also cause mucormycosis. Those with renal failure, diarrhea, and malnutrition in low-birth-weight infants are also at risk.
Diagnosis of mucormycosis is done by observing both symptoms and using investigations that include CBC, ESR, FBS, PPBS, HbA1C, LFT, KFT with electrolytes and Viral markers (HIV/HBV/HCV), diagnostic nasal endoscopy, imaging techniques like CECT, Nose, and PNS, CEMRI Brain Orbit and Face, KOH staining & microscopy, Histopathology, and Fungal culture.
Treatment of mucormycosis includes early or late stage surgical debridement i.e. removal of dead, damaged, or infected tissue along with strict glycemic control and requisite medication.
Step down or salvage therapy include treatment with broad-spectrum azoles available in both parenteral and oral formulations, Amphotericin B, and injection of Liposomal Amphotericin.
Prevention, as always, is better than cure.
The black fungus can be prevented by having a clean environment where there is no exposure to any decaying organic matter including decaying bread, fruits, vegetables, soil, compost, etc. Diabetics need to control their sugar levels.
In people already infected with COVID-19, monitoring of glucose in patients requiring steroid therapy is essential. Indiscriminate use of steroids should be avoided at all costs. Antibiotics and antifungals should also be used only when indicated.
People using oxygen cylinders at home must ensure that they fill the humidifier with distilled or sterile water, avoid un-boiled tap water or mineral water, fill it to about 10mm below the maximum fill line and never let it pass above the maximum fill line.
Check its lever twice daily, top-up when required, and change it daily. Washing the humidifier with mild soapy water is essential.
The good news about black fungus is it can be easily prevented. All it requires is for you to be alert about its causes. There is nothing to fear if you do so for those you love.
(Dr Marcus Ranney is a Champion of Wellbeing, a frontline medic in the fight against COVID-19. Dr Ranney is the Founder of Human Edge, a business platform that provides the competitive advantage of wellbeing. Reach him on Twitter or Instagram on @docmranney.)
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