Mucormycosis is a rare infection. It is caused by exposure to mucor mold which is commonly found in soil, plants, manure, and decaying fruits and vegetables.
It affects the sinuses, the brain, and the lungs and can be life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS.
What causes mucormycosis?
Mucormycosis, also known as black fungus or zygomycosis, is caused by a group of mold called Mucormycetes.
These fungi live in the environment, particularly in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood, according to the Center for Disease Control and Prevention.
When someone breathes these fungal spores, they are likely to get an infection that commonly affects the sinuses or lungs.
Medical experts say mucormycosis is an “opportunistic infection” – it latches on to people who are battling illnesses or are on medications that lower the body’s ability to fight infections.
Patients with COVID-19 have weak immunity and a large number of them are put on steroids in order to control a hyperimmune response, thus making them susceptible to other fungal infections such as mucormycosis.
The majority of mucormycosis infections have been seen in COVID-19 patients with diabetes or those with underlying and undetected high blood sugar.
India’s poor air quality and excessive dust in cities such as Mumbai, make it easier for the fungi to thrive.
Mucormycosis is like fast-spreading cancer that invades the body.
How is it diagnosed?
Symptoms include pain and redness around the eyes and nose, a fever, headache, coughing, vomit with blood in it, black and bloody nasal discharge, pain on one side of the face and in the sinuses, blackish discoloration over the nose, tooth pain, and painful and blurred vision.
It depends on the location of the suspected infection. A sample of fluid from your respiratory system may be collected for testing in the lab; otherwise, a tissue biopsy or a CT scan of your lungs, sinuses, etc may be conducted.
How is it prevented?
Use masks if you are visiting dusty construction sites.
Wear shoes, long trousers, long sleeve shirts, and gloves while handling soil (gardening), moss, or manure.
Maintain personal hygiene including a thorough scrub bath.
When to suspect?
1-Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheekbone
2-One sided facial pain, numbness or swelling.
3- Blackish discoloration over the bridge of nose/palate Toothache, loosening of teeth, jaw involvement.
4-Blurred or double vision with pain
5- Fever, skin lesion; thrombosis & necrosis (eschar) Chest pain, worsening of respiratory symptom
Mucormycosis is expensive and difficult to treat and has a mortality rate of upwards of 50%.
While it is treated with antifungals, Mucormycosis may eventually require surgery. Doctors have said that it is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs.
Management of Covid patients with mucormycosis is a team effort involving microbiologists, internal medicine specialists, intensivist neurologist, ENT specialists, ophthalmologists, dentists, surgeons (maxillofacial/plastic) and others.
Life after surgery for Mucormycosis
Mucormycosis can lead to loss of the upper jaw and sometimes even the eye. Patients would need to come to terms with loss of function due to a missing jaw — difficulty with chewing, swallowing, facial aesthetics, and loss of self-esteem.
Be it the eye or upper jaw, these can be replaced with appropriate artificial substitutes or prostheses. While prosthetic replacement of the missing facial structures can commence once the patient stabilizes after surgery, it is important to reassure patients about the availability of such interventions instead of leaving him to panic with the sudden unforeseen loss, augmenting a post-Covid stress disorder which is already a reality.