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The Latest Black Fungus Epidemic

Medikoe HealthTech Expert

Medikoe HealthTech Expert

  80 feet road indira nagar, Bengaluru     May 24, 2021

   6 min     

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Overview

If you are someone who keeps us with the news, you will have heard of the black fungus or mucormycosis. It is a kind of fungus affecting patients recovering from COVID-19. Recently, the black fungus going around in Rajasthan was declared an epidemic. It has also been observed in patients recovering from COVID-19 in states such as Delhi, Gujarat and Maharashtra.

What is Mucormycosis or ‘Black Fungus’?

Mucormycosis or black fungus is a rare fungal infection that manifests in the skin while affecting the brain and lungs. This condition is caused by a group of fungi called the mucormycetes, which naturally exist in the environment.

This fungus attacks people who are immunocompromised, in this case, COVID-19 patients who have been given strong medicines. Since the body is on heavy medication, it reduces its ability to find pathogens in the environment, allowing fungal infection. Patients with black fungus find their lungs and sinuses infected because of accidentally inhaling fungal spores in the air.

Mucormycosis is rare; it was only recently that doctors found the fungus invading patients who were recovering from COVID-19. Most of them needed surgery.

But, anyone with a healthy immune system can avoid the contraction of black fungus.

What happens when infected with Black Fungus?

The initial signs that point towards black fungus include experiencing pain and redness around the eyes or nose, along with fever, headache, bloody vomit, coughing, shortness of breath, and altered mental status. 

One should consider mucormycetes infection, should they find the following symptoms.

  • Sinusitis — Inflamed sinuses, with a blocked nasal passage, congestion, or blackish/bloody nasal discharge
  • Pain on one side of the face, localized throbbing on the cheekbone, numbness or swelling in the face.
  • Notice a blackish discoloration over the bridge of the nose/palate;
  • Teeth will have loosened, and there will be Jaw involvement
  • Impaired vision; either blurry or double vision, and it’s painful to use the eyes
  • Thrombosis, necrosis, skin lesion;
  • Pain in the chest, pleural effusion, respiratory symptoms become severe

Although experts have suggested that not all cases of blocked noses or bacterial sinusitis should allude to the black fungus, especially when considering immunosuppression and/or Covid-19 patients on immunomodulators.

At the same time, be sure to get the diagnosis right.

Treatment for Mucormycosis

As it is a fungal infection, the right treatment course would antifungal medication. But based on the extent of the condition, the patient might even require surgery. To avoid contracting the disease, doctors stress the utmost importance of keeping chronic disorders like diabetes at bay while also advising patients to keep a check on the usage of steroids and altogether discontinue immunomodulating drugs.

Since the body requires proper hydration, the patient is mainly treated with infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy for at least 4-6 weeks.

Experts also pointedly request patients to control hyperglycemia, keep proper track of blood glucose level after being discharged following Covid-19 treatment. The same is to be expected of diabetics. 

Steroid usage should be monitored appropriately and taken at the correct time, with accurate dosage and duration. This is important.

A vast team of microbiologists, internal medicine specialists, intensivist neurologists, ENT specialists, ophthalmologists, dentists, surgeons (maxillofacial/plastic), and others are required to manage mucormycosis in covid patients.

After Mucormycosis Surgery

Though mucormycosis is rare, it can lead to extreme complications. Patients may lose the upper jaw or even the eye.

After surgery, patients might find it difficult to chew and swallow the food. It could affect the patient mentally due to the change in facial aesthetics, causing them to develop low self-esteem. On the other hand, patients can consider getting artificial substitutes or prostheses in place of the eye or the upper jaw. 

The patient can get a prosthetic replacement for missing facial structures, but this procedure can only be started once the patient stabilizes after surgery. To avoid panic in the patients, doctors are advised to explain to them about the alternate options, even if the procedure will take place weeks later. This can prevent the patient from going into a full-fledged panic due to this unforeseen loss. Experiencing such a panic could lead to a post-Covid stress disorder.

Doctors are also supposed to make sure that they plan the surgery well beforehand to accommodate the loss of the jaw or an eye. Even if one can do a prosthetic reconstruction after surgery, it is important for doctors to have interim solutions in order to have better long-term outcomes. 

How can one prevent it?

Mucormycosis is a rare condition, and it barely occurs in people. Yet, there are some patients who are much more vulnerable to the condition when compared to others.

Conditions like diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, and comorbidities — post-transplant/malignancy, voriconazole therapy, etc. increases the risk of acquiring the fungal infection, as the body cannot fight back as easily with these pre-existing conditions. In addition to that, patients with cancer or those who have recently had an organ transplant.

People who have health problems or take medicines that lower the body’s ability to fight germs and sickness are very vulnerable.

It is important for people to wear masks while visiting dusty construction sites. Cover your body with clothing and accessories. Wear shoes, long trousers, long-sleeved shirts, and gloves while in muddy areas or while handling soil (gardening), moss, or manure. It is important to maintain proper personal hygiene, including a thorough scrub bath.

Conclusion

In the end, black fungus is a rare fungal disorder. Currently, it manifested as a side effect to these unfortunate times we are in. Though it only occurs in patients recovering for COVID-19, it is important for everyone to be extremely precautious. Better safe than sorry. 

Wear masks at all times, wash your clothes, take daily baths, and always carry a sanitizer. Maintain a safe distance from everyone, be it, patients or people. This could help prevent a lot of trouble. Remember, only go out if it's an absolute necessity. Sacrifice some luxuries for a safer tomorrow. 

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Tags:  viral infection,bacterial infections,General Surgery,eyes,fungus; fungal infection; post covid infection, immunosupression, immunocompromised, eye surgery, black fungus

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