Expert’s take on 7 things you need to know about ‘Black fungus’

About black fungus

Even as Covid cases decline marginally in the country, a serious fungal infection, known as mucormycosis, has started affecting several people. Known commonly as ‘black fungus’, the disease often manifests in the skin and also affects the lungs and the brain. With rising cases of mucormycosis across States, several questions and misconceptions are floating regarding the disease.

“Mucormycosis is a rare infection and when it affects a patient, it appears black in colour and thus the name Black Fungus,” Dr Venkat Raman Kola, Clinical Director, Department of Critical Care Medicine, Yashoda Hospitals explains in an interaction with Namrata Srivastava.

What is mucormycosis?

Mucormycosis is a rare infection. It is caused by exposure to mucor mould which is commonly found in soil, plants, manure, and decaying fruits and vegetables. It affects the sinuses, the brain and the lungs and can be life-threatening in diabetic or severely immuno-compromised individuals, such as cancer patients or people with HIV/AIDS.

How prevalent is this disease?

Generally, in the pre-Covid times, mucormycosis was seen in diabetic and immunocompromised patients. Although this fungus is present in the environment and it is not possible to protect against it, very rarely can it affect a healthy person

How does this fungus affect the patients?

This fungus affects various parts of the sinus- maxillary, ethmoid, sphenoid, and frontal- lungs, brain and some other organs such as liver. This is a very dangerous fungus that sits inside the sinuses once a patient inhales them. In a patient with diabetes and immuno-compromising issues, it can grow very rapidly in these areas. It eats away the flesh, tissues and bones near the eyes and nose of the patient. It can also cause lung pneumonia.

Why is mucormycosis affecting the Covid patients?

The blood sugar levels fluctuate in the Covid patients. If the patient also has diabetes, then the chances are that their sugar levels shoot up. This is also happening in non-diabetic or pre-diabetic patients. Diabetes lowers the body’s immune defences.

At the same time, to help fight Covid-19, patients are prescribed steroids which act like fuel to the fire. The use of steroids reduces immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients. This drop in immunity could be the reason behind rising cases of mucormycosis.

What are the symptoms of mucormycosis?

The patient complains of nose blockage or congestion, and there’s black or bloody nasal discharge. There can be local pain on the cheekbone in some patients. There could be black patches of skin around the nose.

Blurred or double vision with pain is another sign of this fungus. Patients may also experience swelling of and pain in the eye and drooping of eyelids. In some patients, we have also noticed chest pain, worsening the respiratory distress. People who have been diagnosed and treated for Covid should be cautious about these signs.

What is the diagnosis and treatment for mucormycosis?

We do a CT Scan of the part of the body to understand if the part is eroded due to the fungus and through endoscopy, test the sample in the microbiology lab. If the tests are positive for the fungus, we have to do a surgery of that body part and aggressively remove the fungus completely. Along with the surgery, anti-fungal injection — Injection Amphotercin B — is used to ensure it doesn’t grow again.

There are two forms of injections available in the market. The first, which has been used for at least 50 years is Deoxycholate. However this injection is ‘nephro toxic’, which means it can severely affect the kidney of the patient. The second injection which is less nephro toxic is Liposomal, but it is very costly and a single day’s therapy of this injection cost between Rs 25,000 to Rs 50,000. Other second line drugs are Injection Isuvaconazole and Injection Posaconazole — both are very expensive medicines.

What can be done to prevent mucormycosis?

Patients should monitor their blood sugar levels and control them. Also, use the steroid judiciously. Although this disease can’t spread from one human touch the other, I urge you to use clean, sterile water in humidifiers during oxygen therapy.

Also, do not consider all cases of blocked nose to be bacterial sinusitis, especially in the context of immunosuppressors and/or Covid-19 patients on immuno-modulators. Seek aggressive investigations, as appropriate for detecting fungal etiology.

About Author –

Dr. Venkat Raman Kola, Clinical Director, Yashoda Hospital, Hyderabad

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