After a whole year of long-suffering from a pandemic of coronavirus, and even after hitting the second wave, which has now slowly step down, a new word continuously hits the screens of television. Every news channel and newspaper was showing how dangerous the disease is, which is known as mucormycosis infection. Now everybody keen to know what is mucormycosis, what is a black fungal disease.
When I came to know about mucormycosis infection, I was remembering something about the disease which is very rare.
Then I gone through my books and internet searches to know more about the black fungus disease.
My main query was why India is the target of this very rare disease. and what are the numbers of cases? Because although all the world passed through the pandemic of coronavirus but from nowhere news has come regarding the spread of mucormycosis.
To Find out the answer, I have spent many hours over the internet to know exactly what is mucormycosis.
And then I found it to be a very dangerous rare fungal infection disease. it is a Mucormycosis infection. Also known as Black fungus disease. Because it produces black patches at the source of infection.
Nowadays many friends ask me what is mucormycosis covid infection. What are mucormycosis symptoms and how mucormycosis spread?
On the other way many also keen to know what is black fungal infection after covid, what is a black fungal infection of the skin, how the black fungal disease spread.
To answer all these queries, I am writing this article in detail.
What is mucormycosis Infection? What is a black fungal infection?
Mucormycosis infection is a very rare fungal infection. It is also known as a black fungal infection. It is caused by exposure to mucor mould ( microscopic filaments of fungus) which is commonly found in soil, plants, manure, and decaying fruits and vegetables. It is also found in soil and air and even in the nose and mucus of healthy people.
It affects the sinuses (Maxillary air sinuses, frontal air sinuses )(sinuses are small cavities) the brain and the lungs. It could be more serious and life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS.
But why it has appeared in this era of coronavirus infection. The answer to the question is lies in the treatment applicable for coronavirus. Because as such there is no definite treatment for coronavirus Although we use remedesivir antiviral drug, its role is limited. Coronavirus makes our lung inflamed and to decrease inflammation we practised giving steroid as an inflammatory drug.
As we know India is the capital of Diabetes and more than 70% of patients are uncontrolled. Why they are uncontrolled we cannot discuss here.
But uncontrolled diabetes patient with coronavirus infection and also received steroid while admission to the hospital. These are the main victims to contract mucormycosis disease.
Some another less contributing factors are giving oxygen to the patient at the home Level. In a home, the relative of the patient could not administer oxygen through flow metre properly. They may not be aware of proper care and humidification of oxygen. This may cause dryness of nasal mucosa which may form a nidus for any type of infection.
If they administer oxygen to the patient for a longer duration by adding simple tap water to the humidifier, then piping of the oxygen catheter catches fungus which can spread to the nasal cavity.
Following are the main factors responsible for the increasing number of cases of mucormycosis infection in India.
Number 1 – uncontrolled diabetes
Number 2 – non-judicial use of injectable steroids
number 3 – Improper use of oxygen at home Level
Number 4- Improper use of mask
In India, many people don’t care about the mask. They think if we cover our nose and mouth with any handkerchief, towel, then that will also do the job of the mask. I don’t want to spend extra money to purchase any good quality mask or N95 high-quality mask. They use any low-quality Mask and do not wear it properly. They use it for many days without washing and drying it. When the mask became moist, still they continuously use it and that causes the development of fungus over it.
Doctors believe mucormycosis, which has an overall mortality rate of 50%, maybe being triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients.
Why we use steroids in covid cases
Steroids reduce inflammation within the lungs for Covid-19 and appear to stop a number of the damage that will happen when the body’s system goes into overdrive to repel coronavirus. But they also reduce immunity and push up blood glucose levels in both diabetics and non-diabetic Covid-19 patients.
It’s thought that this drop in immunity could be triggering these cases of mucormycosis.
Diabetes lowers the body’s immune defences, coronavirus exacerbates it, and then steroids which help fight Covid-19 act like fuel to the fire.
What are symptoms, Black fungal infection symptoms.
The symptoms of mucormycosis depend on where in the body the fungus is growing.
It can enter the body through the nose to lung, nasal sinuses, eye, brain and face.
It can enter through the cut mark of our body to the skin.
It can be reached to the stomach via the mouth.
It can be reached into the blood through any system and spread all over the
body.
Hence the symptoms depend on which system is involved.
Symptoms of rhinocerebral (Air sinus and brain) mucormycosis include:
- One-sided facial swelling
- Headaches,
- Nasal or sinus congestion or pain,
- Bloody nasal discharge,
- Fever,
- Ptosis (coming out of the eye from orbit), proptosis of the eyeball. loss of movements of the eyeball.
- Vision disturbance.
- Necrotic black lesions on the hard palate (mouth) or nasal turbinate( inside nose)
- Black lesions on the nasal bridge or upper inside of the mouth.
Symptoms of pulmonary (lung) mucormycosis infection include:
- Fever
- Cough
- Chest pain
- Shortness of breath
Cutaneous (skin) mucormycosis infection
Development of blisters or ulcers. Blackening of the infected area.
Skin Pain, warmth, excessive redness, or swelling around a wound.
Symptoms of gastrointestinal mucormycosis infection
- Abdominal pain
- Nausea and vomiting
- Gastrointestinal bleeding
Disseminated mucormycosis (Blood infection)
It occurs in people who are already sick from other medical conditions, so it can be difficult to know which symptoms are related to mucormycosis. Patients with disseminated infection in the brain can develops coma.
Types of Mucormycosis infection
Rhinocerebral mucormycosis
Pulmonary (lung) mucormycosis
Cutaneous (skin) mucormycosis
Gastrointestinal mucormycosis
Disseminated mucormycosis (Blood infection)
What is the Investigation for confirmation of Mucormycosis?( Black fungal disease)
There is no specific Investigation to diagnose at an early stage. According to clinical finding, a History of uncontrolled diabetes, or Steroid received, the doctor can decide about the diagnosis. As treatment needs to be started as early as possible, the doctor can start antifungal treatment to stop the further progression of the disease. Because the culture of fungus or biopsy of the tissue may take few more days.
The doctor can order some blood investigation and MRI scan to see the extent of the damage caused by the disease.
Transmission of mucormycosis, How black fungal disease spread.
Transmission of this fungal infection occurs through inhalation, inoculation at the site of trauma, or ingestion of spores from the environment. The infection specially cathed to uncontrolled diabetic patients with a low level of immunity.
Hence these cases found in very less number. But nowadays because of covid hospitalisation and long term steroid therapy, the cases seem to be rise.
Treatment of the mucormycosis infection.
Early recognition of the disease and prompt administration of appropriate antifungal treatment is important for improving outcomes for patients with mucormycosis. The drugs used as antifungal therapy are Amphotericin B, posaconazole, and isavuconazole.
Amphotericin B often used as a first-line treatment.
In some cases, surgical debridement or resection of infected tissue is often seen as necessary, particularly for rhinocerebral, cutaneous infection.
The efficacy of other treatments such as hyperbaric oxygen therapy is uncertain but have been useful in certain situations.
Complications of black fungal infection
The deadly complication is the infection of the eyeball. In the case of rhinocerebral infection, as the infection spread from the nose to the cerebrum, the eyeball gets infected along with its optic nerve and peripheral tissue.
Loss of vision, loss of movements of the eyeball and pain at there, are the typical symptoms. Hence to save the life of the patient, the eyeball needs to be removed from the socket, so that we can arrest the spread of infection to the deeper site such as our brain.
Sequelae
The overall prognosis depends on several factors, including the rapidity of diagnosis and treatment, the site of infection, and the patient’s underlying conditions and degree of immunosuppression. The overall mortality rate is approximately 50%, which means 50 % of cases died due to this infection. Only early identification and treatment can lead to better outcomes.
Risk groups who can contract disease easily
Risk groups for mucormycosis involved the following cases.
Persons with uncontrolled diabetes,
Cancer patients who are on chemotherapy
Stem cell transplant or organ transplant Patients who are on immunosuppressant agents.
Persistent neutropenia means very low white blood cells count in blood, Prolonged steroid therapy for any reason,
Skin trauma, burns, or surgical wounds,
Iron overload, Intravenous drug abuse, Malnourishment, and premature babies.
By knowing all these, do not get frightened. It’s all a game of immunity. Even coronavirus infection also became severe due to our immunity. Coronavirus itself only cause infection to our lung which can be self-limited, means can be self-healed even if not treated with an antiviral drug like Remdesevir.
It heals because of our immunity which becomes activated and start killing everything which looks like a virus. But when this response is enormous, then our lung develops oedema and our 02 saturation fall.
This time, this happened because of our immunity response.
But still, we need good immunity. Hence eat well, do daily exercise, which is lacking among Indians. Eats all fruits regularly and wear a mask always properly.
Thank you.
Recently DRDO India announced a new drug that could be a gamechanger in coronavirus battle.
Very informative article. Such enterprise to make people aware about health issues is really praiseworthy.
Thank you suresh.