Black Fungus - Causes and Symptoms

Black fungus or mucormycosis, is a rare , uncommon, yet dangerous infectious disease. The condition is most commonly seen in individuals with weak or impaired immune systems or in patients who have been under long-term steroid medications. A black fungal infection can have life-threatening consequences if not recognized and treated promptly.

What is Black Fungus?

A black fungal infection, often called mucormycosis, is a rare but dangerous illness. Mucormycetes, a type of mould that causes this illness and typically affects the skin, brain, lungs, and sinuses. The route through which the mould spores can enter into the body is through the inhalation of the spores when in contact with contaminated soil, decaying bread, vegetables, compost piles, or other items.

Causes of Black Fungus

Exposure to black fungal moulds is one of the main causes for the infection of black fungus. These microbes are found in leaves, compost piles, soil, rotting wood, stale bread, and spoilt vegetables. Inhaling these airborne mould spores from an infected area can cause the deposition of these moulds and growth in the tissues of eyes, face, lungs, sinuses, and skin, and can sometimes affect the nervous system. As a result of which the below symptoms can be presented in the various areas of the body:

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Symptoms of Black Fungus (Mucormycosis)

Upper and Lower Respiratory Symptoms of Black Fungus

• Cough
• Fever
• Headache
• Chest pain
• Nasal obstruction
• Breathing difficulty or breathlessness
• Black lesions on the nasal bridge or inside the oral cavity

Skin Related Symptoms of Black Fungus

Mucormycosis can appear anywhere on the body as a skin infection.

• Blisters
• Ulcers
• Fever
• Oedema
• Redness
• Darkened skin tissue
• Blackened boils
• Painful lesions

Eye Related Symptoms of Black Fungus

• Blurred vision
• Blood clots
• Double vision
• Excessive Tearing
• Headache
• Malaise
• Congestion
• Blood-tinged secretions

Gastrointestinal Symptoms of Black Fungus

• Diarrhoea
• Bloody stools
• Nausea and vomiting
• Vomiting blood
• Pain abdomen

In addition, a person may become exposed to the fungus through a wound, cut or burn on their skin (cutaneous exposure). The burn or wound in these cases eventually turns infected. Even though a variety of moulds can be found in the natural world, not everyone who is exposed to them will become infected with fungi. An individual may be more susceptible to this type of infection if they have weakened immune function.

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Risks and Susceptibility

The following health conditions might increase the chances of getting the black fungus infection. Individuals who have had COVID-19 and have one or more of the following comorbidities are at significantly higher risk of developing this disease.

• Cancer
• Burns
• HIV/AIDS
• People on immunosuppressants
• Uncontrolled diabetes
• Recent organ transplant
• Stem cell transplant
• Neutropenia
• Chemotherapy
• Long-term steroid use

Diagnosis of Mucormycosis/Black Fungus

A comprehensive clinical examination is necessary prior to starting treatment for mucormycosis. A thorough medical history and physical examination are part of this process to confirm the diagnosis and rule out other illnesses.

• Medical History and Physical Examination: A thorough clinical examination helps identify early signs and symptoms of mucormycosis, such as unusual skin lesions, facial pain, or vision changes.
• Clinical Signs: Include persistent headaches and tissue necrosis, which may present as eschar (black scabs) in the nasal or oral cavities. Commonly noticed eye symptoms include eye redness, swelling, pain, blurring of vision, severe facial pain, and localized numbness.
• Diagnostic Imaging: CT scans help in the detection of areas affected by mucormycosis, especially in the brain and paranasal sinuses.
• Laboratory Tests: Tissue biopsies are examined under a microscope to identify the presence of the fungus. Specific staining techniques are used to visualize the fungal elements. Though rarely required, molecular techniques such as DNA sequencing and PCR can be employed to confirm the presence of Mucorales, the fungal pathogens responsible for mucormycosis.

Treatment for Black Fungus

• Antifungal Medication: Upon diagnosis, prompt initiation of antifungal therapy is crucial. Treatment often begins with intravenous (IV) administration of antifungal drugs to rapidly control the infection. Once stabilised, oral antifungal therapy may be continued.
• Surgical Intervention: Some cases may require  surgical removal of infected tissue to stop the infection from spreading and progressing to deeper layers of the affected organ.
• Early diagnosis and prompt treatment are key to improving outcomes for patients with this serious fungal infection. By following a comprehensive approach that combines medical treatment, surgical intervention when necessary, and supportive care, mucormycosis can be effectively managed.

Prevention of Mucormycosis

While it is impossible to completely avoid inhaling fungal spores, steps can be taken to reduce the risk of mucormycosis, particularly for those with underlying health conditions that increase vulnerability.

• Exposure to Dust and Soil Should Be Minimised
  Dusty or soil-rich environments, such as construction sites or excavation areas, should be avoided. If presence in these areas is necessary, a face mask, like an N95, should be worn to provide protection from inhaling spores.

• Contaminated Water Should Be Avoided
  Potentially contaminated water, including flood water or water in buildings damaged by natural disasters, should be avoided, as these environments may harbour harmful fungi.

• Protection Should Be Used During Outdoor Activities
  For those with weakened immune systems, activities involving contact with dust and soil, such as gardening or yard work, should be avoided. If such activities are necessary, protective clothing, including shoes, gloves, long pants, and long sleeves, should be worn. Any cuts or scrapes should be cleaned with soap and water as soon as possible.

When to visit a doctor for black fungal infections?