Mucormycosis: The Black Fungus Affecting COVID-19 Patients

Mucormycosis is a serious but rare fungal infection that is occurring as a post-Covid-19 complication.

The increasing number of mucormycosis cases- a fungal infection, colloquially "black fungus"- among patients recovering from COVID-19 is being detected in some states. The Indian Council of Medical Research has issued an advisory after Dr. VK Paul, member NITI Aayog mentioned about the existence of the rare, fungal infection. However, Dr Paul said that it is very uncommon among patients who do not have diabetes. He asked the people to control their sugar levels to prevent this disease.

He said that the cases are being studied, assuring that it is not a big outbreak.

What is Black Fungal infection?

Mucormycosis, as this fungal infection is called, is a serious but rare fungal infection caused by a group of fungi called mucormycetes. They are present in the air as well as in contaminated surfaces and enter the body through the nasal cavities.

Hospitals in Mumbai, Delhi, Ahmedabad, and Bangalore that have been reporting the presence of this fungal disease since December have now raised red flags suggesting that Mucormycosis cannot be ignored as a post-COVID complication. While the Ministry is now closely monitoring the trajectory of this disease, there have been reports of deaths related to the case. Some reports, circulating for months, have also mentioned the loss of eyesight after recovering from COVID as a result of the fungal infection.

BOOM spoke to Dr. Manish Munjal, ENT specialist at Sir Ganga Ram Hospital and Dr. Hetal Marfatia, Head of Department, ENT, KEM Hospital, Mumbai to understand the severity of the disease.

"COVID-19 patients are complaining about loss of vision and numbness in the nose after recovering. We have even lost a few patients post-recovery to the black fungus," Dr. Marfatia said. While Sir Ganga Ram Hospital had reported four early deaths way back in December, Dr. Munjal said that the number of patients complaining about symptoms of mucormycosis has risen in the past few months.

"Once in the body, the fungi moves through the nasal cavity and causes necrosis-instant cell death if not checked. It moves through the nose to the eyes, and is most fatal if it reaches the brain," Dr. Munjal explained. A culture is collected from the people exhibiting symptoms and a potassium hydroxide stain is applied to the culture to test for positivity.

What are the symptoms?

The fungal infection is usually diagnosed by numbness in the nose. The other symptoms of mucormycosis are eye swelling, one side swelling of the face, nasal or sinus congestion, excretion of black mucus. Both the doctors emphasised that the symptoms manifest faster in people living with diabetes.

"Patients recovering should be more vigilant about any symptoms and should visit a physician immediately for tests," said Dr. Munjal.

According to the ICMR, it is pertinent that if a person observes signs of sinusitis- nose congestion or blockade, or pain in the cheekbone, black discolouration of the bridge of the nose, toothache, double vision, chest pain, they should consult a doctor and take the requisite tests.

Who are at risk?

People with lower immunity are at a higher risk of contracting this fungus and being infected. Diabetics are at a higher risk of being infected by the fungus. A 2005 study noted that the mortality rate of this fungus is around 54%.

According to Dr. Munjal, the use of the essential medicines to treat COVID-19 such as steroids and Tocilizumab trigger low immunity in a subset of people making them susceptible to contracting this airborne infection.

Dr. Marfatia agrees that the use of steroids among pre-diabetic and diabetic patients is driving the increasing number of mucormycosis cases that are being reported across the country.

Taking note of the role of steroids in the occurrence of black fungus, Dr. VK Paul requested that both steroids, as well as oxygen humidifiers, be used rationally to avoid a larger outbreak of this fungal infection. "When a patient is on oxygen support, it should be ensured that water does not leak from the humidifier. Patient's hygiene is also important," explained Dr. Paul. He even suggested that the rampant use of Tocilizumab and Itolizumab be rationalised.

The ICMR advisory highlights that people with uncontrolled diabetic mellitus as well as those with a prolonged ICU should be more alert as they are at a higher risk of contracting this fungal infection.

How to prevent it?

Besides following social distancing rules, wearing masks, and washing hands, Dr. Munjal says diabetic patients should be in touch with their physicians. "I urge people recovering from COVID-19 to start consuming immunity-boosting food and live a lifestyle that boosts their immunity."

Dr. Marfatia further adds that whether diabetic or not, people suffering from COVID-19 as well as those who still have not been diagnosed with the virus or the fungus should keep their surroundings clean and maintain good hygiene. "COVID-19 is not over and is not going to be any time soon. Requesting people to be vigilant and wary throughout recovery as well as in general."

The ICMR advisory adds to this list by asking patients to monitor their glucose levels along with using steroids, antibiotics, and anti-fungals judiciously. It also requests people to report any symptom and carry out the potassium hydroxide test for the early detection of the fungus.

Anti-fungal medicine is the best way to treat this infection. Many times if the tissue is badly affected, doctors also insist on surgery to remove the infected tissue.

The ICMR advisory asks that patients keep their diabetes under control. Doctors should also reduce prescribing steroids to their patients as well as immuno-modulating drugs, the ICMR prescribes.

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