Mucormycosis / Black Fungus

introduction

What is Black Fungus?

Mucormycosis or Black fungus 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.

Symptoms of 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 black fungal disease 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.

Black fungus disease is like fast-spreading cancer that invades the body.

Causes of Mucormycosis

The major cause for cataract is age. Other than that, various factors can cause the formation of cataracts like:

  • Previous or untreated eye injury
  • Hypertension
  • Previous eye surgery
  • UV radiation
  • Long exposure to sunlight
  • Over usage of certain medications
  • Hormone replacement therapy

Symptoms & Causes

Mucormycosis is caused by exposure to mucor mold which is commonly found in soil, plants, manure, and decaying fruits and vegetables. These...

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Risk Factors

People who are immunocompromised are more at risk of contracting this rare infection. Loss of immunity can happen due to:

  • Diabetes, especially with diabetic ketoacidosis
  • Cancer
  • Organ transplant
  • Stem cell transplant
  • Neutropenia 
  • Long-term corticosteroid use
  • Injection drug use
  • Too much iron in the body (iron overload or hemochromatosis)
  • Skin injury due to surgery, burns, or wounds
prevention

Prevention

  • Use masks if you are visiting dusty construction sites.
  • Periodic health exams even after having recovered from COVID to keep your blood sugar under control is necessary. 
  • Wear shoes, long trousers, long sleeve shirts, and gloves while handling soil (gardening), moss, or manure.
  • Maintain personal hygiene including a thorough scrub bath

Treatments

Black fungus diagnosis is challenging because the symptoms are common to several other conditions It s diagnosis hence involves a...

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FAQ

What is black fungus ?

Mucormycosis or Black fungus 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.

The early symptoms depend on the area of infection. In case of infection in the nose, sinuses, and eyes – the earliest signs are nasal blockage, facial numbness, and double vision.

Some of the symptoms to look out for are:

  • Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheekbone
  • One sided facial pain, numbness, or swelling.
  • Blackish discoloration over the bridge of nose/palate Toothache, loosening of teeth, jaw involvement.
  • Blurred or double vision with pain
  • Fever, skin lesion; thrombosis & necrosis (eschar) Chest pain, worsening of respiratory symptom

No, Mucormycosis or Black fungus in humans is not contagious. People who are immunocompromised due to health conditions such as diabetes, cancer, or organ transplants are more at risk of this disease. Increased corticosteroid use during COVID -19 also weakens the immunity, which may make patients susceptible to Black Fungus.

Diagnosis of black fungal infection in the nose, sinus, and eyes is done through methods such as endoscopic examination of the sinuses and laboratory testing of the nasal tissue. This along with a CT or MRI scan can help clinch the diagnosis.

Yes, Mucromycosis is treatable.Treatment of Mucormycosis is a teamwork involving an ENT (Ear, nose ,throat ) specialist, ophthalmologist, neurologist and a radiologist. In advanced cases, surgery might be required along with antifungal medication such as Amphotericin B.

Some of the precautions one can take are:

  • Periodic health checkups to monitor parameters such as blood sugar after recovery from COVID -19. 
  • Usage of masks when in dusty environments such as construction sites.
  • Wearing gloves and protective clothing while gardening or dealing with soil, manure or organic substances.

According to the Centers for Disease Control and Prevention (CDC), black fungus mainly affects people with health conditions or those on medications that weaken their immune system. Some of the factors that make a person prone to mucormycosis black fungus disease are: –

  • Cancer
  • Diabetes
  • Organ Transplant
  • Skin injury
  • Excess iron in the body
  • Low White Blood Cell (WBC) count
  • Stem cell transplant
  • Long term usage of drugs such as immunosuppressants and corticosteroids

With the increase in the number of black fungus cases, extra care needs to be taken. Experts say that there are certain precautionary measures one can follow during and after hospitalization for COVID-19 to minimize the risk of black fungus face infection. Here are some of the precautions one can take during hospitalization: –

  • Keep diabetes and diabetic ketoacidosis under control.
  • Prevent the usage of immunomodulating drugs.
  • Stop using any antifungal medications.
  • Minimize the use of steroids.
  • Use sterile water for humidification while administering oxygen.
  • Maintain good oral hygiene with povidone-iodine gargles and mouthwash.

Some of the precautions one can take post-hospitalization: –

  • Keep your blood sugar level under control.
  • Stay indoors.
  • Focus on nasal and oral hygiene.
  • Wear an N-95 mask when you go out.
  • Maintain social distancing.
  • Avoid going to places with a lot of dust.
  • Avoid activities where you are in close contact with soil or manure (for example, gardening)
  • Wear gloves, shoes, long trousers, long sleeve shirts when you go out.

With the rise on COVID-19 cases, black fungus epidemic has come across. This is so deadly that in certain cases, mucormycosis black fungal infection requires surgical intervention that may result in the loss of the upper jaw and sometimes even the eye. Black fungus patients would need to come to terms with the loss of function due to a missing eye or jaw. Prosthetic reconstruction will play a big role in rehabilitation after surgery.

Research is yet to check whether COVID-19 and mucormycosis nose infection are related in any way. However, most mucormycosis infections recorded in the initial waves of the COVID-19 pandemic in India have been in people who recovered from COVID-19.

Mucormycosis fungus, if not diagnosed, can be deadly. Also, because there is no black fungus vaccine. It enters the body and blocks the blood vessels, cutting off the blood supply to the tissues. Many cases of mucormycosis have been found in the upper jaw or maxilla, sometimes causing the entire jaw to detach from the skull. This usually happens because the blood supply to the upper jaw bone is cut off due to the fungus. The dead bone then detaches like a denture coming off.

The infection is so aggressive that it can spread faster than cancer. In about 15 days, it may spread from your mouth to your eyes and to your brain within a month. However, it should be noted that the infection is not contagious, meaning it does spread with contact.

The surgery performed is quite aggressive with the removal of infected tissues. For example, the eyeball, eye socket, oral cavity, or bones of the nasal cavity.

The symptoms of black fungus on skin include excessive redness, pain, warmth, or swelling of the wound.

White and black fungus are different from each other. Black fungus is a disease that affects the face, eyes, nose and brain. It may even cause loss of vision. While white fungus is far more dangerous as it affects the lungs and may damage other body parts.

Black fungus can be treated through surgery, where the infected tissues are removed. While to prevent white fungus, you need to maintain good oral health by regularly rinsing your mouth and brushing your teeth.

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