Mucormycosis | Black Fungus | Everything you should know

The entire nation is battling the COVID19 pandemic. While the medical infrastructure stands completely stretched, the problem of Mucormycosis is seeing a sharp surge amongst the COVID19 patients.

We have noticed a surge in cases of “MUCORMYCOSIS “ , the black fungus , in “COVID” recovered patients treated with steroids and who are diabetic too.

Diabetic patients generally have iron overload, similar to patients on iron therapy or even iron chelation therapy which acts as a sideropore for the mucor.

Mucor thrives and feeds on iron which is its metabolic support.

Although the covid recovered cases with diabetes are on the rise, it can affect patients who are non diabetic too, since use of steroids during COVID makes you vulnerable to the fungus as your immunity is already exhausted. So it wise to take proper precautions even if you are non diabetic.

Also, during the course of COVID treatment many a times people get transient diabetes due to steroid use.

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What are the symptoms of mucormycosis?

1. headache

2. facial pain

3. nasal congestion

4. loss of vision or pain in the eyes

5. swelling in cheeks and eyes

6. black crusts in the nose.

Causes

Mucormycosis is caused by exposure to mucormyete molds. These organisms occur in:

• leaves
• piles of compost
• soil
• rotting wood

You can contract mucormycosis by breathing in affected mold spores in the air. This is referred to as a sinus (pulmonary) exposure. In turn, you may develop the infection in your:

• central nervous system (rarer)
• eyes
• face
• lungs
• sinuses

The fungus can also infect your skin via a cut or burn (cutaneous exposure). In such cases, the wound or burn ends up becoming the area of infection.

While these types of molds can naturally occur in the environment, not everyone exposed will get the fungal infection. You may be at an increased risk of contracting this type of infection if you have a weakened immune system.

Conditions that may increase your risk include:

• burns
• cuts and scrapes
• cancer
• recent organ transplant
• diabetes (especially if it’s not being treated properly)
• surgery

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This “black fungus” or “Mucor” is present in dust or soil [ENVIRONMENT FACTOR ] around us , but generally our immunity is sufficient to repel it efficiently from our bodies. Wise to keep our home and surroundings dust and soil free for a while.

This “black fungus” or “Mucor” gets access or invades our body once our immunity response is exhausted/ weak/ slow/ inefficient secondary due to conditions like “COVID”, “Diabetes”, “HIV”, “transplant patients on steroids”, and the bodies defenses have lowered the guard due to its inefficiency to act swiftly to kill the fungus.

This fatal disease earlier was considered to be untreatable , atleast before the advent of “Amphotericin B antifungals”.

Cases had 100% mortality rate before 1954.

The dictum is that the disease should be diagnosed fast and treatment started within 6 days, then the chances of survival are high.

Treatment comprises of 3 pronged approach: 

1. maintaining the blood sugars in control , 

2. “Amphotericin antifungal injection”, and 

3.endoscopic evaluation/debridement of the paranasal sinuses by a team of “Maxillofacial and ENT surgeons”, maxillectomy of the diseased jaw if needed.

Generally the disease presents as headaches, heaviness around nasal sinus, vomiting in some cases, pain and swelling around eyes , redness in eyes, pain in teeth and jaws, mobility and weakening of teeth, blackish discoloration or alteration of the soft tissue of the oral cavity like a burned “eschar”.

Many a times we need to remove the upper jaw and even the eye to limit the infection and stop it from invading the brain.

Diagnosis is made by gold standard biopsy histopathology of the tissues harvested and “KOH” mount on slides for staining which gives classical appearance of the fungus as branched aseptate hyphae at right angles.

Though disease is not transmissible or contagious like COVID , you should take care.

Precautions to be taken to avoid mucormycosis are :- 

wear masks in outdoors, 

avoid dusty places, 

frequent use of hand sanitiser , 

mouth rinses with warm saline rinses, 

keep your blood sugars in check, 

ample steam inhalation.

Share this with your family & Friends, spread awareness about Mucormycosis.