Mucormycosis aka Black Fungus

Source: By The Times of India

Mucormycosis is a deadly fungal infection found in some Covid-19 patients with uncontrolled diabetes and prolonged intensive care unit (ICU) stay. The infection which is also known as 'Black Fungus' affects the brain and the lungs.

Cases of Black Fungus have been on the rise prompting the government to issue an evidence-based advisory about the disease on 9 May 2021. The advisory said that the fungal infection mainly affects people who are on medication that reduces their ability to fight environmental pathogens.

Mucormycosis, known colloquially as the black fungus, is a rare but dangerous fungal infection caused by a group of moulds known as mucormycetes, which are present naturally in the environment.

They only cause serious complications when a patient has pre-existing health problems or has taken medication that compromises the immune system.

The fungal spores commonly enter through inhalation and affect the sinuses or lungs. They can also enter through an open cut or wound and infect the skin.

Warning symptoms of black fungus include pain and redness around the eyes and nose, fever, headache, coughing, shortness of breath, bloody vomits and altered mental status, stated the government advisory. In Covid-19 patients with diabetes and immuno-suppressed individuals, one must suspect Mucormycosis if there is:

  1. Sinusitis, nasal blockage or congestion
  2. One-side facial pain or numbness
  3. Blackish discoloration over the bridge of the nose or palate
  4. Toothache
  5. Blurred or double vision with pain
  6. Skin lesion
  7. Thrombosis
  8. Chest pain and worsening respiratory symptoms

Major risk factors for this disease include uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, malignancy and voriconazole therapy, the ICMR-health ministry advisory stated.

Mucormycosis is treated with antifungal drugs but can eventually require surgery. As per experts, controlling diabetes is of utmost importance, reducing steroid use and discontinuing immunomodulating drugs.

As per the government advisory, medical treatment includes installing peripherally inserted central catheter, maintaining adequate systemic hydration, infusion of normal saline intravenously before Amphotericin B infusion and anti-fungal therapy for at least six weeks besides monitoring the patient clinically with radio imaging for response and to detect disease progression.

To prevent the disease, blood glucose level should be monitored post-Covid discharge and also in diabetic patients; steroids should be used judiciously in correct timing, dose and duration; clean sterile water should be used in humidifiers during oxygen therapy; and antibiotics and antifungal medicines should be used correctly.

The disease can be managed by controlling diabetes, discontinuing immunomodulating drugs, reducing steroids and extensive surgical debridement- to remove all necrotic materials, according to the advisory.