Black Fungus: What Should You Know about Which is Emerging in People with COVID-19?

A generally rare fungal infection called mucormycotic has raised in India recently, mainly impacting people recovering from COVID-19.

This type of fungal infection is scarce, and that it may be affecting people whose immune systems have been impaired by the coronavirus. The use of steroid drugs in these patients may partially explain some of the rises, while the immune-compromised state of COVID-19 patients could explain others.

Even as India struggles to contain a deadly surge of COVID-19, doctors are now reporting cases of a rare infection called the “black fungus,” happening among people recovering from the disease.

As per CDC, this black fungus infection is called mucormycosis and is caused by a group of molds called mucormycetes that typically live in soil and decaying organic matter.Fungi in this family are generally found in the environment – in soil, for example – and are often associated with decaying organic material such as fruit and vegetables.

Fungi grow rapidly and have a black-brown fuzzy appearance in the laboratory.Fungi that cause human disease grow well at body temperature and in acidic environments – the kind seen when tissue is dead, dying or associated with uncontrolled diabetes.

What should you know:

Mucormycosis is a rare, invasive, fungal opportunistic infection that causes serious, sometimes fatal disease.

Symptoms:

As per CDC, Mucormycosis can impact various parts of the body, showing different sets of symptoms.

• If the infection grows in the sinuses and brain symptoms, include fever, one-sided facial swelling, headache, and nasal or sinus congestion.

• If your lungs are affected by the fungus, you can experience cough, chest pain, and shortness of breath.

• When mucormycosis attacks the digestive system, you may experience abdominal pain, nausea and vomiting, and gastrointestinal bleeding.

It’s an environmental mold, which once it infects you, is very morbid and has a high mortality.

People with COVID-19 theoretically could be at higher risk due to an immune reaction or inflammation locally in the sinus tract.

There are 3 ways humans can contract mucormycosis – by inhaling spores, swallowing spores in food or medicines, or when spores contaminate wounds.

Inhalation is the most common. We breathe in the spores of many fungi every day. But our immune systems and lungs, if healthy, generally prevent them from causing an infection.

Mucormycosis usually is not spread from person to person but is found in the environment. However, due to the spread level, it is too early to say how this is spreading.Mucorales can be found in soil, rotting food, bird and animal excretions, water and air around construction sites, and moist environments.

Stun Your Readers

Earlier very few mucormycosis infections were associated with Covid-19 in countries other than India. Why is the situation in india e so different now?

Mucormycosis was already far more common in India than in any other country before the pandemic. It impacts an estimated 14 in every 100,000 people in India compared to 0.06 per 100,000 in Australia.

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Global outbreaks of mucormycosis usually are due to contaminated products such as hospital linens, medications, and packaged foods.But the situation of mucormycosis in India suggests it's not coming from a single contaminated source.

Another factor that is playing a role in India is Diabetes.If diabetes is poorly controlled, blood sugar is high, and the tissues become relatively acidic, a suitable environment for Mucorales fungi to grow. This was recognized as a risk for mucormycosis in India (where diabetes is increasingly prevalent and often uncontrolled) and worldwide well before the Covid-19 pandemic.

Diabetes was seen in 40% of all mucormycosis cases published in scientific journals globally between 2000 and 2017.

Who is at risk:

• In a recent small study, researchers indicated that COVID-19 patients with diabetes that were treated with steroid drugs had a significantly increased risk of experiencing fungal infections like mucormycosis.If our lungs are damaged and our immune systems suppressed, such as is the case in patients being treated for severe Covid-19, these spores can grow in our airways or sinuses, and invade our bodies' tissues.

• As per research, while mucormycosis is comparatively rare, increased use of chemotherapy and steroid drugs like those used to treat some COVID-19 patients may be increasing its frequency.

• Dr. Nikhil Bhayani, an infectious disease expert at Texas Health Resources, says that mucormycosis can be treated with antifungal agents like amphotericin B, isavuconazole, and posaconazole.

How is Mucormycosis Treated?

Mucormycosis is a severe infection and needs to be treated with prescription antifungal medicine, usually amphotericin B, posaconazole, or isavuconazole.

These medicines are given through a vein (amphotericin B, posaconazole, isavuconazole) or by mouth (posaconazole, isavuconazole). Other medicines, including fluconazole, voriconazole, and echinocandins, do not work against fungi that cause mucormycosis. Often, mucormycosis requires surgery to cut away the infected tissue.

Mucormycosis is just one of many opportunistic infections that can occur with COVID-19. There is a lot that is unknown about the consequences of COVID-19 and its relationship with other diseases.

References:

1. Treatment for mucormycosis | mucormycosis | fungal diseases | CDC. https://www.cdc.gov/fungal/diseases/mucormycosis/treatment.html. Updated 2021. Accessed May 23, 2021.

2. Pan AS, Srinath L. Mucormycosis in a patient with AIDS receiving systemic steroids. J Am Osteopath Assoc. 2013;113(9):708-711. Accessed May 23, 2021. doi: 10.7556/jaoa.2013.037.

3. Moorthy A, Gaikwad R, Krishna S, et al. SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis [published online ahead of print, 2021 Mar 6]. J Maxillofac Oral Surg. 2021;1-8. doi:10.1007/s12663-021-01532-1

4. Mucormycosis: The 'black fungus' maiming covid patients in india. BBC News. -05-09 2021. Available from: https://www.bbc.com/news/world-asia-india-57027829. Accessed May 23, 2021.