Should we worry about the ‘black fungus’ or is it just a new hype

Mucormycosis — the new disease that’s all over the media

The Black Fungus or Mucormycosis is a rare but serious fungal infection caused by infection from the Mucormycetes group of fungi (or mold as fungus is commonly known). The Mucor fungus is ubiquitous— it is present in soil, plants, manure, decaying fruits and vegetables. It is even found in the nose and mucus of healthy people. The infection gets its colloquial name from the black lesions it causes.

While fungal diseases are common among plants, only a very small fraction of them affect humans. The main reason for this is that we have intricate immune systems. However, when the immune system has been breached by another illness, fungi that are otherwise harmless take advantage and invade human tissues. These are called opportunistic infections. Mucormycosis is opportunistic as well, which is why there is a sudden growing number of cases among Covid patients since their immunity has been weakened by steroids treatment and other conditions like diabetes.

Why is there so much hype suddenly and what is the connection with Covid?

In our last post we had explained how the body’s fight against Covid triggers an inflammatory immune response. In some Covid cases, the patient is treated with steroids like Dexamethasone as steroids reduce inflammation in the lungs and help stop some of the damage that can happen when the body’s immune system goes into overdrive to fight off the coronavirus. But steroids also reduce immunity and push up blood sugar levels in both diabetic and non-diabetic Covid patients. Unfortunately there is a rise of unsupervised and unauthorized use of steroid therapy and this is making the situation worse.

But while there is a lot of hype in the media, it is important to know who is under risk of getting infected by black fungus— a very small percentage of Covid patients who check one or more of the boxes below —

  • Covid patients with uncontrolled diabetes and diabetic ketoacidosis (a complication of diabetes where the body produces harmful acids called ketones);
  • Covid patients who have received high doses of intravenous or oral steroids for prolonged periods;
  • Covid patients who have received immunomodulators (drugs used in diseases like cancer to modify the immune system’s response)

It doesn’t mean that if you have diabetes and you get Covid or if you’re getting steroids therapy you should get scared. It only means that you should be aware of what the symptoms of mucormycosis are.

It is very important for Covid patients who are getting steroids therapy to ensure that they’re getting the right treatment authorized by their doctor and not taking any unprescribed steroids.

One reason for the hype is that even though only a very small percentage of Covid patients are infected by the black fungus, if it’s not detected and treated early it can become serious. Around 50% of the patients who have a serious infection die from it.

But don’t worry about the hype. Just be wary of the symptoms and contact a doctor early if you are diabetic and/or have had steroids treatment and you detect the symptoms below.

Symptoms

Mucormycosis presents symptoms in the nose, eye and skull area or as a respiratory infection or as a skin infection.

Nose, eye and skull area: Facial pain, numbness, or swelling; black or bloody nasal discharge; headache or pain in the eyes and orbit; toothache, loosening of tooth, or jaw involvement; blurring or double vision with pain; tingling sensation on the face; fever, and blackish skin lesions.

Respiratory infection: Cough, fever, headache, nasal congestion or blockage, black or bloody nasal discharge, blood in sputum after cough, chest pain, and sinus pain.

Skin infection: With a skin infection, mucormycosis can develop within any part of your body. It may initially occur at the site of skin trauma, but it can quickly spread to another area. Be on the lookout for symptoms such as: blackened skin tissue, blisters, fever, redness, swelling, tenderness and ulcers.

Since mucormycosis spreads rapidly in the body, it is very important to contact your doctor if you have these symptoms along with Covid or if you’ve recently overcome Covid.

When do symptoms usually show up?

Mucormycosis infection symptoms can show up as early as 8–10 days after Covid is detected in a patient to as late as 60 days after it. The most important time period to be wary of symptoms is two-weeks to six-weeks after Covid is detected in the patient.

Treatment

Mucormycosis patients are treated by giving intravenous (IV) antifungal medications or in some cases by surgical debridement. Surgical debridement involves cutting away all infected tissue. Removing infected tissue has been shown to stop the infection from spreading further.

If a patient responds well to IV therapy and tissue removal, the doctor will likely remove IV and give the patient oral medications to take.

Common antifungal medications that your doctor may prescribe for mucormycosis include:

  • amphotericin B (given through an IV)
  • posaconazole (given through an IV or orally)
  • isavuconazole (given through an IV or orally)

Some prevention tips

  1. Ask the hospital staff to sterilize the humidifiers used during oxygen therapy thoroughly.
  2. It is better if patients recovering from Covid stay indoors until they regain their immunity, especially if they’re diabetic.
  3. Patients who work in farming or do gardening as a hobby — it is advisable to avoid this for a few weeks after recovering from Covid.

Summary

It is good to be aware of what the black fungus infection is, but not get scared. It only affects a very small percentage of covid patients who have uncontrolled diabetes and get treated with steroids. Contact your doctor early if you see symptoms.

Originally published in Medium: https://medium.com/@ovum.pediatrics/should-we-worry-about-the-black-fungus-or-is-it-just-a-new-hype-4b42d6993e35

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