Black Fungus

The fungal infection is caused by a group of molds called mucormycosis. These molds live throughout the environment. Mucormycosis mainly affects people who have health problems or those who are taking medicines that lower the body’s ability to fight germs and sickness. 

What are the symptoms of Black Fungus?

The common symptoms associated with the disease include headache, facial pain, nasal congestion, loss of vision or pain in the eyes, swelling in cheeks and eyes, and black crusts in the nose. The US Centre for Diseases Control and Prevention estimates Mucormycosis with an overall all-cause mortality rate of 54 percent.

How Harmful is Mucormycosis or Black Fungus?

“Mucormycosis can be very dangerous if left untreated can cause mutilating damage to face, nose, eyes with disfigurement and loss of vision and also cause invasive brain infection,” Dr. Mahesh Kumar, Consultant -Internal Medicine, Narayana Health City, Bengaluru, told IANS.

While “Aspergillus and Candida are more common fungal infections, but this infection is dangerous because it involves the sinus and brain and happens to those who are in an immunocompromised state and/or to patients on steroids,” added Dr Vikas Maurya, Director, and HOD, Pulmonology, Fortis Hospital, Shalimar Bagh.

According to health experts, Mucormycosis (previously called zygomycosis) has been a cause of disease and death in transplants, ICU, and immunodeficient individuals for a long time. However, it is the rapid increase in numbers seen in unsuspected Covid patients which is a matter of grave concern. Patients who recover from the Covid infection are increasingly being pushed back into the ICUs. Last year, Mucormycisis had caused high mortality with many patients suffering from loss of eyesight, removal of nose and jawbone.

Who Can Get Black Fungus or Mucormycosis?

People with diabetes, those on steroids and humidified oxygen for a long time, and Covid patients with pre-existing comorbidities are the most at risk. Others include patients like those post chemotherapies, those on long-term immunosuppressive drugs.

ICMR Guidelines For Black Fungus

The evidence-based advisory for screening, diagnosis, and management of the disease was released by the Indian Council of Medical Research (ICMR) and the Union health ministry.

“Mucormycosis, if uncared for, may turn fatal. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air,” it said.

Warning symptoms include pain and redness around the eyes and nose, fever, headache, coughing, shortness of breath, bloody vomits, and altered mental status, the advisory stated.

In Covid-19 patients with diabetes and immuno-suppressed individuals, one must suspect mucormycosis if there is sinusitis, one-side facial pain or numbness, blackish discoloration over the bridge of the nose or palate, toothache, blurred or double vision with pain, skin lesion, thrombosis, chest pain, and worsening respiratory symptoms, it said.

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

Treatment of Black Fungus

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.

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, it said.

The risk of this fungus can be avoided by avoiding the prolonged use of steroids. The treatment also involves anti-fungal and surgery (if required) to remove the affected area. Judicious use of steroids and immunosuppressive drugs especially in elderly, immunocompromised, cancer, and diabetic patients with Covid, are needed during the course of treatment, experts advised.

How It’s Different From The Regular Skin-Based Fungal Infections? 

Black Fungus is an internal fungal infection while other fungal infections occurs on the skin with blemishes, clusters, lumps or discoloration of the skin.