- Dr Veena Desai Malhotra
Introduction
A serious, but otherwise rare fungal infection, has been observed in a number of Covid-19 patients recently.
A rare but serious fungal infection, known as mucormycosis and colloquially as “black fungus”, is being detected relatively frequently among Covid-19 patients in some states. The disease often manifests in the skin, also affects the lungs and the brain.
What is mucormycosis?
Mucormycosis, commonly called BLACK FUNGUS, is a rare but serious fungal infection caused by a kind of fungus called mucormycete, which is abundant in the environment. It mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.
Mucormycosis is a very rare infection. It is caused by exposure to mucor mould which is commonly found in soil, plants, manure, and decaying fruits and vegetables. It is ubiquitous and found in soil and air and even in the nose and mucus of healthy people.
Doctors believe mucormycosis, which has an overall mortality rate of 50%, may be triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients.
Steroids reduce inflammation in the lungs for Covid-19 and appear to help stop some of the damage that can happen when the body's immune system goes into overdrive to fight off coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients.
What are the symptoms of mucormycosis?
Warning signs include
- pain and redness around the eyes or nose, with
- fever, headache, coughing, shortness of breath, bloody vomits, and
- altered mental status.
According to the advisory, infection with mucormycetes should be suspected when there is:
*Sinusitis — nasal blockade or congestion, nasal discharge (blackish/bloody);
* Local pain on the cheek bone, one-sided facial pain, numbness or swelling;
* Blackish discoloration over bridge of nose/palate;
* Loosening of teeth, jaw involvement;
* Blurred or double vision with pain;
* Thrombosis, necrosis, skin lesion;
* Chest pain, pleural effusion, worsening of respiratory symptoms.
Experts advise that one should not count all cases of blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or Covid-19 patients on immunomodulators.
Do not hesitate to seek aggressive investigations for detecting fungal infection, they advise.
Oral Manifestations Of Mucormycosis - Usually include bone exposure and necrosis, which demands histopathological examination to confirm the diagnosis because of its nonspecific features and possible similarities to bacterial osteomyelitis, trauma, and iatrogenic infections.
Oral mucormycosis without any other systemically compromised organs is quite uncommon. Other case reports of oral manifestations related to mucormycosis identified triggering or predisposing factors for local and systemic conditions.
The most important risk factors of invasive mucormycosis in these patients are
- trauma,
- diabetes,
- glucocorticoid use,
- hemopoietic malignancies,
- prolonged neutropenia,
- allogeneic hematopoietic stem cell transplant, and
- solid organ transplant.
Hence, the infection is dire and causes
- blindness,
- organ dysfunction,
- loss of body tissue due to infection, and
- ultimately death.
How does COVID-19 trigger mucormycosis?
Mucormycosis is a unique but serious fungal infection which is seen in people with poor immunity or who are immuno-compromised. That is why almost always mucormycosis is seen in people who have uncontrolled diabetes, those who are on steroids or other immunosuppressant medication where their immunity is compromised. In the process of treating COVID-19, many times we have to use steroids and other drugs to control their disease process or lung infection and save their life.
In that process their immunity also gets affected. A weakened immune system and the use of such life-saving medication during the course of illness can increase their susceptibility to get mucormycosis.
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