Black Fungus (Mucormycosis) in COVID-19 patients

Black Fungus (Mucormycosis) in COVID-19 patients

Introduction

• Hospitals across the country have started to report a number of cases of mucormycosis, an invasive fungal infection affecting patients who have recently recovered from COVID-19.
• In common parlance, it also goes by the name ‘black fungus’, a direct reference to the blackening that is characteristic of the disease.

What is mucormycosis?

• Mucormycosis is an aggressive and invasive fungal infection caused by a group of molds called mucormycetes.
• It can affect various organs but is currently manifesting as an invasive rhino-orbito-cerebral disease, crawling through the sinus and working its way to the brain, affecting the ear, nose, throat, and mouth.
• While it is not contagious, it can cause a lot of damage internally and can be fatal if not detected early.
• While mucormycosis is an old disease, what is perhaps new and concerning is the sudden increase in the invasive form of the sinus variant, which involves the orbit, and at times the brain.

How prevalent is the disease?

• The Centers for Disease Control and Prevention, U.S., calls it a serious but rare disease.
• Without population-based estimates, it is difficult to determine the exact incidence and prevalence of mucormycosis in the Indian population.

What causes the disease?

• Diabetes mellitus is the most common underlying cause, followed by haematological malignancies and solid-organ transplants, according to a comparative study of several papers on the incidence of mucormycosis in India, published in a recent issue of Microorganisms.
• Diabetes mellitus was reported in 54% to 76% of cases, according to a report.
• What seems to be triggering mucormycosis in patients post COVID-19 is, an indiscriminate use of a high dose of steroids in COVID-19 patients, sometimes even in minimally symptomatic patients.
• This leads to spikes in the sugar level among diabetics, which, in turn, renders them vulnerable
  • Steroids in some COVID-19 patients might be a life-saver, and therefore, they become a double-edged sword.
  • Rational use of steroids is necessary, and constant monitoring of sugar levels and resorting to insulin use to control these levels if required, is essential, he added.
• The use of monoclonal agents like Tocilizumab may be a factor, too.
• He added that while the fungi are present in the environment, the use of nasal prongs and other devices for oxygen delivery and possible breach of sterile conditions can possibly lead to cross-infection and hospital-acquired infection.

Does the disease cause any distinct symptoms?

• Stuffy nose, bloody, blackish, or brown discharge from the nose, blackish discolouration of the skin, swelling or numbness around the cheek, one-sided facial pain, toothache or jaw pain, drooping of the eyelids or eyelid swelling, double vision, redness of eyes, and sudden decrease in vision.
• The main line of treatment is an anti-fungal drug called amphotericin B.
• Surgery to remove the fungus growth might also be warranted.

How can mucormycosis be prevented?

• Following appropriate treatment protocols as recommended by the World Health Organization for COVID-19, including rational use of steroids and monoclonal antibodies only when they can help a patient, is important.
• It is important to keep blood sugar levels under control and ensure that appropriate calibration of oral drugs or insulin is done from time to time