Just when people started thinking that Covid itself was too much to bear, a new diseae came into news called as MUCORMYCOSIS also known as THE BLACK FUNGUS DISEASE .
 
Let’s see what is this disease and why is this a cause of concern and can it cause the next pandemic !!??

What is MUCORMYCOSIS?

 
MUCORMYCOSIS (also known as ZYGOMYCOSIS or GLOMERULOMYCETES) is a fungal infection.
Just like most other fungal infections, this is also an opportunistic fungal infection.
This is not a new disease but rather an old one. It is one the common causes of fungal infection in immuno-compromised individuals.
 

Fungus causing MUCORMYCOSIS?

MUCORMYCOSIS is caused by any of the following fungus.
  • RHIZOPUS
  • MUCOR
  • ABSIDIA
  • RHIZOMUCOR

 

Where does this fungus of MUCORMYCOSIS reside?

 
This fungus is an opportunistic fungus and is generally present as saprophyte in our surrounding environment in soil or bread.
The following can be a potential locations where this fungus can grow-
  • soil
  • dirty/irregularly cleaned air coolers or air conditioners
  • dirty water which can come in contact with human
  • stale/old bread

 

How Does MUCORMYCOSIS SPREAD?

As discussed, this fungus is present in soil and surroundings, so accordingly there can be multiple ways of entry for this fungus
  • inhalation
  • injury
    • fungus present in soil may enter through trauma
  • contact with dirty water or dirty surface
  • presence of dirty water in cooler or air conditioners
 

SYMPTOMS OF MUCORMYCOSIS

MUCORMYCOSIS mostly presents as – RHINO-OCULO-CEREBRAL disease- meaning spreading in nose, sinuses and eyes.
 
It is currently famous as BLACK FUNGAL INFECTION because the lesion presents as a black mass inside the nose.
 

Starting symptoms / Warning symptoms of Mucormycosis

The symptoms may start with a minor complaint, as small as a headache.
This headache may be present in-
  • frontal area
  • around nose
  • behind the eyes
  • in area around cheek
Ideally, a patient should immediately consult the doctor a soon as these symptoms occur. This is because the fungus starts to spread even before the symptoms are expressed outside.
 
This BLACK FUNGAL INFECTION has the capacity to spread to nearby organs such as-
  • sinuses
  • eyes
  • brain
  • and to lungs and other organs via blood vesels.
It will start invading your blood vessels and lead to endothelial damage and thrombosis and soon involve other organs. After spreading to various organs, it causes a systemic inflammatory reaction in the body.
 
As a result, as more organs get involved, its severity increase and chances of survival decreases
 
Symptoms depend on the organ or involvement. This usually start from nose
  • NOSE
    • nasal congestion
    • black colour collection
  • ORBITAL CELLULITIS
    • redness and swelling surrounding eyes
    • this may also cause one sided face swelling
  • LUNGS
    • cough
    • breathlessness
  • BRAIN
    • delirium
    • seizures (fits/convulsions) 
    • coma
  • SKIN
  • INTESTINES
    • abdominal pain
    • vomiting 
    • gastrointestinal bleeding
    • SPLEEN

Warning signs of MUCORMYCOSIS!!

WHO ARE AT THE RISK OF MUCORMYCOSIS ?

NOT EVERYONE CAN SUFFER FROM BLACK FUNGAL INFECTION !!
 
This is an opportunitic infection meaning it will cause disease only if your immunity is low.
The normal human immunity is enough to tackle this fungus. As discussed earlier, this is present in our surrounding as an environmental saprophyte. So there are chances many of us might have got the fungus but there were no symptoms, thanks to your immunity!!!
 
Thus MUCORMYCOSIS occurs only in those who have low immunity
 
These include patients with-
  • DIABETES MELLITUS
    • uncontrolled diabetes
  • RENAL DISEASES
    • end stage renal diseases
  • TRANSPLANT RECIPIENTS
    • those who have recieved organ transplant
  • STEROID USERS
    • high dose steroids for medical or non-medical reasons
    • long time steroid users
  • NEUTROPENIA
    • decreases neutrophils in blood
  • COVID
    • especially in immunocompromised state
  • DISEASES DECREASING IMMUNITY
    • certain blood cancers.
    • cancer treatment – radiotherapy or chemotherapy
  • BURNS patient
  • IRON THERAPY
    • patients who are on iron therapy as this fungus get attracted to excess iron.
    • This is for those who consume excess of iron due to medical reasons and does not mean you should stop consuming iron. 

TREATMENT OF MUCORMYCOSIS

This disease is fought on Medical and Surgical fronts depending on the symptoms and case presentation.
It requires ANTIFUNGALS, SURGICAL DEBRIDMENT and controlling the leading factor.
 
 
As discussed earlier, Mucormycosis can spread to adjacent organs. The treatment of Murcormycosis is done on the basis of area of spread. You must contact an ENT surgeon to understand the management of he disease.
 
The treatment may involve any of the below mentioned surgical procedures according to the area invloved-
 
  • sinus involvement – Debridement using endoscopy
  • cheek bone involvement – Maxilectomy (removal of cheek bone)
  • eye involvement – Enucleation (removal of eye)
  • jaw bone involvement – Mandibulectomy (removal of jaw bone)
  • brain involvement – removal of the involved part of brain

SEVERITY OF MUCORMYCOSIS

  • MUCORMYCOSIS is an emergency situation. It is mostly neglected in the starting stages because the symptoms are not severe in the starting of the disease.
 
As discussed earlier, Mucormycosis can spread through blood vessels, and when this fungus starts to invade vessels, not much time is left with the patient!! 
As more organs get involved, its severity increase and chances of survival decreases.
 
This infection has a HIGH DEATH RATE (50%).
Death rate is more in people with very low immunity and in patients in whom this disease has spread to multiple organs (>90% death rate).
If not disseminated, death rate is <10%.
 
If untreated, the chances of survival are less than 5%. 
 
Medicines and surgery do help a lot in decreasing death rate. But don’t show effect in highly disseminated cases or in patients with very low immnunity.
 

HOW TO PROTECT AGAINST MUCORMYCOSIS ?

  • keep your immunity high
  • keep your diabetes in control
  • use mask to prevent inhalation of fungus
For people with low immunity-
  • wear mask while going out
  • avoid getting in contact with dust
  • make sure to keep your surroundings clean
  • make sure to keep your coolers and air conditioners clean
  • stay away from contaminated food and water
  • Consult your doctor to start anti-fungal

Why is Mucormycosis a problem during COVID?

COVID cause some serious inflammatory reaction in the body. It affects not only the lungs but also the immunity of the body.
 
Plus in patients who needed admission and oxygen support are started on steroids (the only drug shown to have positive effect on COVID patient). Steroids cause huge alterations in the blood glucose levels and the patients must be monitored for glucose level on constant basis for couple of months even after discharge. If necessary, insulin injections must be started for the same.
These Steroids and the increased sugar level lead to drop in the immunity of the patient.
 
But Steroids are the only drugs that have shown the best effect in the treatment of Covid, hence there is no better alternatve in treatment of Covid patients.
 
During recovery phase of Covid (that is after 15 days of covid) the body’s immunity levels are still low and need some weeks to recover back to the previous levels. During that time make sure to have nutrition to build your immunity.
 
Until recently, the cases of this disease were very less and hence the demand for anti fungal drugs was very less.
But this rapid increase in cases has increased the demand of these drugs and the Pharma companies are not able to cope up to the increased requirement  of these anti-fugals. Hence, there is scarcity in availability of the medications.
 

Post Covid care for patients for protection against Mucormycosis-

  • Keep sugar in check (if requrired, take insulin injections)
  • DO NOT self medicate or alter the dosage of steroids on your own.
  • Have plenty of fruits and vegetables
  • Have protein supplements
  • Have multivitamins supplements 
  • Keep wearing mask even after recovery
  • Make sure to have cleanliness around you
 

That’s all for this topic !!

 
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THANKS FOR READING !
STAY SAFE !
STAY HYGEININC !

 

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SOURCES-
  1. https://www.cdc.gov/fungal/diseases/mucormycosis/symptoms.html
  2. Textbook of Essentials of medical parasitology and ananthanarayan by apurba sastry.
  3. Epidemiology and outcome of zygomycosis: a review of 929 reported cases by Maureen M Roden and others DOI: 10.1086/432579
  4. Epidemiology and clinical manifestations of mucormycosis by George Petrikkos DOI: 10.1093/cid/cir866
  5. Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management by Brad Spellberg and others
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