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Insights into Editorial: What is mucormycosis or ‘black fungus’ in Covid-19 patients

 

Context:

The Union government has asked the States to declare mucormycosis, the fungal infection being reported in COVID-19 patients, an epidemic.

In a letter to the States, Health and Family Welfare Ministry said declaring the black fungus infection seen in COVID-19 patients an epidemic would lead to health facilities screening for it and reporting all such cases to the government.

 

About Mucormycosis:

  1. Mucormycosis is a rare but serious infection that is caused by a group of moulds called mucormycetes. Colloquially termed ‘Black Fungus’, it was previously known as
  2. Mucormycosis largely affects people who have health problems or use medicines that depress the body’s ability to combat germs and illness.
  3. It reduces the ability to fight environmental pathogens.
  4. It most commonly afflicts the sinuses or the lungs after inhaling fungal spores from the air.
  5. It can also happen on the skin after a burn, cut or other type of skin wound through which the fungus enters the skin. It can also affect the brain.
  6. People having co-morbities, variconazole therapy, uncontrolled diabetes mellitus, immunosuppression by steroids or prolonged ICU stay can get predisposed to the fungal infection.
  7. Warning signs include headache, fever, coughing, blood vomits, breathlessness and altered mental status.

 

Types of Mucormycosis:

  1. Rhinocerebral (Sinus and Brain) Mucormycosis: It is an infection in the sinuses that can spread to the brain.
    1. It is the most common in people with uncontrolled diabetes and in people who have had a kidney transplant.
  2. Pulmonary (Lung) Mucormycosis: It is the most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant.
  3. Gastrointestinal Mucormycosis: It is more common among young children than adults, especially premature and low birth weight infants less than 1 month of age, who have had antibiotics, surgery, or medications that lower the body’s ability to fight germs and sickness.
  4. Cutaneous (Skin) Mucormycosis: It occurs after the fungi enter the body through a break in the skin (for example, after surgery, a burn, or other types of skin trauma).
    1. It is most common among people who do not have weakened immune systems.
  5. Disseminated Mucormycosis: It occurs when the infection spreads through the bloodstream to affect another part of the body.
    1. The infection most commonly affects the brain, but also can affect other organs such as the spleen, heart, and skin.

 

Spread of Mucormycosis:

  1. People can spread black fungus on coming in contact with the spores from the environment.
  2. In case of the lung or sinus infection the person can be infected after inhaling the spores from the air.
  3. A skin infection can occur after the fungus enters the skin through a scrape, burn, or other type of skin injury.
  4. They are more common in soil than in air, and in summer and fall than in winter or spring.
  5. These fungi are not harmful to most people but for people who have weakened immune systems, breathing in micromycetes spores can cause an infection.

 

Symptoms:

  1. These include pain and redness around eyes and/or nose, fever, headache, coughing, shortness of breath, bloody vomits, and altered mental status.
  2. Warning signs can include toothache, loosening of teeth, blurred or double vision with pain.
  3. Disseminated mucormycosis typically occurs in people who are already sick from other medical conditions, so it can be difficult to know which symptoms are related to mucormycosis.
  4. Patients with disseminated infection in the brain can develop mental status changes or coma.

 

Where are these fungi found?

Mucormycosis is caused by a group of molds called mucormycetes. It is naturally found in air, water and even food.

It enters the body through fungal spores from the air or can also occur on skin after a cut, burn, or skin injury.

 

Mucormycosis affecting COVID-19 patients:

Patients who have high levels of diabetes are at a higher risk of contracting covid-19. When this occurs, they are treated with steroids which compromises their immunity.

According to doctors, steroids can prove to be a trigger for mucormycosis. While steroids help in reducing inflammation in lungs they can decrease immunity and increase blood sugar levels in both diabetics and non-diabetic covid-19 patients alike.

The black fungus disease is an additional burden on the country that is already grappling with more cases and fatalities due to the second wave of the covid-19 pandemic.

 

Why and how it affects Covid-19 patients during or post-recovery?

Medicines used in treating Covid-19 tend to bring down the count of lymphocytes.

Lymphocytes are one of the three types of white blood cells whose job is to defend our body against disease-causing pathogens such as bacteria, viruses, and parasites.

The reduced count of lymphocytes leads to a medical condition called lymphopenia, making way for opportunistic fungal infection in Covid-19 patients.

There is a higher chance of occurrence of mucormycosis in patients whose immune system is not functioning well, and since Covid-19 treatment tends to suppress the working of the immune system, it places such patients at a higher risk of contracting the black fungus infection.

 

Basic Preventive measures to be followed:

  1. Cleaning and replacement of humidifiers (for those using Oxygen Concentrators)
  2. Sterile normal saline should be used in the humidifier bottle and changed daily
  3. Masks should be disinfected daily

 

Way Ahead: Preventive measures to be taken by Covid-19 patients:

People with the following medical conditions should be more careful, they should constantly monitor their health and also take the following preventive measures.

Diabetic Patient (uncontrolled diabetes) + Steroid usage + COVID Positive – all three combined together place one under high risk of getting this infection.

Those who are taking steroids should also keep checking their blood sugar levels. In most cases, one who is not diabetic finds that after taking steroids, the blood sugar level shoots up to 300 to 400. Hence, it is essential to continuously monitor one’s sugar level.

Hence diabetic patients should always monitor and control their blood sugar level.