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Black fungus: All you need to Know

- 5 min read
written by Shield Connect

Mucormycosis has been there in India for decades and has been managed very well by ENT surgeons.

Mucormycosis has been there in India for decades and has been managed very well by ENT surgeons. Its prevalence was very rare and usually affects the immunocompromised patients like diabetics or cancer patients or transplant recipients, etc. but Due to Covid, its prevalence has reached new high.

It is a rare but rapidly progressing infection caused by group of moulds called Mucormycetes. Along with the second wave of COVID-19 infections, A rapid Surge in cases of mucormycosis, commonly called as “black fungus”, has added challenges to the India’s healthcare system.

Mucormycosis can be classified depending on the organ it affects. Signs and symptoms of the infection also differ depending on the infected body part.

1. Rhino orbital cerebral Mucormycosis: Infection occurs when fungal spores are inhaled. Infections occurs in the nose, orbit/ Socket of eye, oral cavity and can even spread to the brain. Symptoms include headache, nasal congestion, nasal discharge (green colour), pain in sinus, swelling on face, bleeding nose, lack of sensation on face and skin discoloration. Invasive rhino-orbital-cerebral mucormycosis spread rapidly from the nose to the eye and the brain. In few cases it may lead to surgical removal the infected eye to stop the infection from reaching the brain.
2. Pulmonary Mucormycosis: When spores are breathed in and reach the respiratory system, it affects the lungs. Symptoms include fever with chest pain, cough and coughing of blood.

Who are at high risk?
Covid 19 is caused by SARS-CoV-2 and is seen to affect old people and it also causes severe inflammatory changes in the lungs and cardiovascular system. It reduces the immunity level of an individual and makes the body more prone to other diseases. Geriatric patients are more likely to have co-morbid conditions like diabetes, hypertension, kidney disease, thyroid disorders etc. which makes them more prone to opportunistic infections like mucormycosis.

Mucormycosiscourtesy: wikipedia.org/wiki/Mucormycosis

Other Cause of Mucormycosis

  • Uncontrolled diabetes and the use of high-dose steroids, which suppress immunity, have been identified as the primary factors behind the cases of black fungus or mucormycosis.
  • The role of steroids in mucormycosis cannot be denied. There are instances where the administration of steroids is taken beforehand or where patients are kept on high doses of steroids during the hospitalization. Those practices can increase the risk of getting Infection.
  • The chances of getting Black Fungus in Diabetic patients or those who have deranged blood sugar levels are also high. The primary reason is diabetes lowers the immune power which makes the individual vulnerable and more prone to the Black Fungus.

Preventive measures

  • Diabetic Patient (uncontrolled diabetes) + Steroid usage + COVID Positive – all three combined together place one under high risk of getting this infection.
  • Therefore, diabetic patients should be always monitored and control their blood sugar level.
  • Fungal spores found in air can easily enter the body through the nose. Wearing masks makes masking up doubly important, in preventing infection. Masks should be disinfected daily.

Treatment options

Usually, Mucormycosis is surgical debridement or removal of all the dead tissue which harbours the fungus. Mucormycosis causes ischemic necrosis, that causes dead tissue to clog the blood vessels. It is most important that all the dead tissue is removed completely, and it may require multiple procedures. Also, an intravenous anti-fungal medication called ‘Liposomal Amphotericin B” is also given for a few weeks till the fungus is fully controlled. Oral antifungal and second-line drugs like Posaconazole also recommended in some conditions.

Dr Nikhil VargeDr Nikhil Varge
MBBS MD (Internal Medicine)
Consultant: Acharya Shri Nanesh Hospital Navi Mumbai

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