What is Mucormycosis- Black fungus?

Mucormycosis, also called black fungus, is a serious disease caused by molds (microscopic fungi that live on plant or animal matter) called- “Mucormycetes.” Previously it was called Zygomycosis. It is a rare but potentially deadly disease. Mucormycosis or black fungus may cause blindness, organ dysfunction, loss of body tissue, or death. Mucormycetes are found everywhere in the environment including soil and plants.

How Mucormycosis or black fungus infects?

Mucormycetes ( fungal spores) are present in the atmosphere. It can affect the areas from where it can be inhaled. On getting inhaled, it affects the sinus or lungs. Through sinus, it can cause infection in the eyes and the brain. It can also cause local infection in the skin if it enters through wounds, cuts, burns, or other types of skin injury.

Mucormycosis can also infect patients admitted to hospitals. It can spread through hospital linens, ventilation systems or can be transmitted through adhesives.

Who are at the risk of Mucormycosis?

The infection of mucormycosis can be caused to anyone at any age. Most people can come in contact with fungal spores almost every day. But with our immune system working at an optimum level defend us from infection. Persons with compromised immune systems are most likely to get the infection. Persons with the following health conditions are more at risk of getting mucormycosis or black fungus infection:-

Diabetes, especially when it not under control.
HIV or Aids
Cancer
Organ transplant
Stemcell transplant
Long term steroid use
Hemochromatosis- High level of iron in the body
Neutropenia- Low W.B.C. count
Metabolic acidosis- Uneven level of acid in the body

Mucormycosis is not a contagious disease i.e. it can not spread from one person or organism to another person or organism. Recently in India, it has been reported in patients with Covid-19.

If the skin is infected, the infected area may look blistered, red, or swollen. It may also turn black or felt warm or painful.

The infection can also spread to other parts of the body through blood. Such a stage is called disseminated mucormycosis. It may infect the spleen or heart. On getting severe it may lead to changes in the mental state, coma, or death.

What are the symptoms of Mucormycosis?

The symptoms of mucormycosis or black fungus depend upon the area being infected.

Symptoms of rhinocerebral (sinus and brain) mucormycosis may include:-

Headache
Nasal or sinus congestion
One-sided facial swelling
Fever
Black lesions on the nasal bridge or upper inside of the mouth.

**Symptoms of Rhinocerebral mucormycosis- black fungus**

Symptoms of Pulmonary (Lung) mucormycosis:-

Fever
Cough
Chest pain
Breathlessness

Cutaneous (skin) mucormycosis:- It may look like a blister or ulcer. The infected area turns black. Other symptoms may include- excessive redness, pain, warmth, and swelling around the wound.

Gastrointestinal Mucormycosis:-

Nausea and vomiting
Abdominal pain
Gastrointestinal bleeding

Disseminated Mucormycosis:- Patients suffering from other medical conditions generally get infected with disseminated mucormycosis. It becomes difficult to differentiate the associated symptoms. Patients suffering from disseminated mucormycosis develop a disturbed mental state or coma.

What are the complications?

Complications associated with mucormycosis-black fungus may include:-

Nerve damage
Blindness
Blood clots or blocked vessels

Mucormycosis can be deadly, if not treated in time. Researchers estimate that approximately 54% of people with mucormycosis could not survive. The likelihood of death depends upon- which part of the body is infected. The outcome can be better for persons with sinus infection than persons with infection in the lungs or brain.

How black fungus can be prevented?

Breathing in spores can not be avoided as they are present everywhere. Our immune system under normal conditions prevents us from infection. But with certain health conditions the risk of getting infection rises. Following few measures may help to lower the chances of getting infected.

Wearing mask (N-95) while going outside, especially in gardens, dusty areas, or areas where one may come across rotting garbage or food. Moreover, wear clothes that cover your skin as much as possible.

For diabetic and other immunocompromised patients controlling blood glucose levels is a must. People on steroids should be constantly monitored and the dosage should be tapered in consultation with the healthcare provider.

People with low immunity should avoid the activities like gardening or yard work. If it can not be avoided, cover your skin with long sleeves, long pants, and shoes. Wash cuts on the skin with soap and water as soon as possible.

Avoid infected water like- floodwater or water from damaged buildings, especially after floods or hurricanes.

Mucormycosis- black fungus spreading during Covid-19 in India.

The fungal spores of mucormycetes are usually inhaled. But our immunes system at optimal levels has the capacity to stop them from developing into an infection. But people with a weakened immune system due to certain health conditions (as discussed above) like- uncontrolled diabetes, leukemia, Covid-19, etc., or people who take medicines like- steroids that lower the ability of the body to fight germs are more prone to infection.

Mucormycosis is a rare disease with a high mortality rate. And is difficult to treat. The rare disease is spreading in Covid-19 patients.

As per Professor Peter Collignon, who has been a member of the world health organization (W.H.O.) expert committee on antibiotic resistance and infectious diseases- The infection, called mucormycosis,” is very serious, has a high mortality, and you need surgery and lots of drugs to get on top of it once it takes hold.”

Collignon said the infection due to coronavirus ( Covid-19) is impacting body immunity. Which enables mucormycetes to cause infection. Mucormycosis is mostly seen in patients with uncontrolled blood glucose levels.

“We give a lot of high dose steroids now to people with Covid -19 if they end up in intensive care as the steroids help to treat inflammation, but the steroids unfortunately also suppress your immune system.”

” So that’s why we don’t like giving steroids to patients longer than we absolutely have to. We are trying to decrease inflammation with steroids, but that actually means your ability to fight normal infections, like fungus is also compromised.”

For treatment please consult your healthcare provider on the appearance of symptoms as early as possible.

Stay safe- Stay healthy.

(For awareness purpose only).