Black fungus (Mucormycosis) is a rare fungal infection caused by a group of molds known as micromycetes. Rhino-orbital-cerebral-mucormycosis (ROCM) is caused by molds of the order Mucorales. In this, there are a few subgroups like Rhizopus, Mucor, Rhizomucor which are most commonly involved in this infection. These fungi invade the surrounding blood vessels and destroy them resulting in tissue necrosis and death. These molds live throughout the environment and their spores are present in the air. They get lodged in the nasal cavity and adjoining sinuses.
On reaching a favourable milieu they ensconce themselves within the tissue. The spores germinate, hyphae outgrow and release destructive juices which digest the host tissue and provide nutrition to the rapidly growing fungi. As they grow in the nasal cavity they relentlessly destroy the surrounding host tissue. The bones in the nasal cavity and sinuses are destroyed. These include the hard palate, the orbital bones, and the skull base bones. Black masses may be seen in the nasal cavity and oral cavity. If it destroys the orbit and enters the eye socket it may cause bulging of the eyes, pain, frozen eye movements, and blindness. Once it enters the cranial cavity by breaching the skull base it blocks major arteries and venous lakes resulting in major life-threatening brain strokes and bleeds.
The spores can sometimes travel into the depths of the respiratory system and get comfortably lodged in the lung parenchyma. Here the fungi grow rapidly, destroying the lung tissue and compromising blood oxygenation. From there it can spread into the circulatory system resulting in an existential crisis.
***** Mucormycosis is not contagious and most people who come in contact with the fungi do not develop an infection.
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Respiratory Related Symptoms:
4) Chest pain
5) Nasal or sinus congestion and pain
6) Shortness of breath
Skin Related Symptoms:
1) Blackened skin tissue
2) Redness, Swelling, Tenderness
People who are susceptible to fungal infections: People with reduced immune response are more susceptible to infection.
Conditions that reduce immunity:
High blood sugars with an acidic environment as seen in diabetic ketoacidosis are the right recipe for the rapid growth of these organisms. Diabetes is also associated with reduced immune response.
1) Steroids medication increases blood sugar levels and decreases the immune response of the body.
3) Blood malignancies, which again results in the defective immune system
4) Patients on immunosuppressants as seen with organ recipients and haematologic stem cell recipients.
5) Patients with excess iron or taking deferoxamine (specifically used in iron overdose).
6) Trauma, burns, and malnourished people.
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Based on clinical suspicion MRI and CT scan of the nasal cavity, sinuses, and brain is performed. These give a clear picture of the presence of the lesion along with its extent. CT chest helps in diagnosis by revealing additional lung lesions. Diagnosis is by microscopic evaluation of the bronchopulmonary lavage aspirate.
Doctors can treat the infection by antifungal medication or performing surgery to remove the affected area. If left untreated, it can be fatal, with a mortality rate of 54%. During treatment, judicious use of steroids (keeping blood sugar levels under control), antibiotics, and other antifungal drugs need to be done.
Occurring in COVID 19 patients:
It can occur any time after COVID-19 infection, either during the hospital stay or several days to a couple of weeks after discharge. The COVID-19 causes favourable alteration in the internal milieu of the host for the fungus and the medical treatment given, unwittingly also abets fungal growth. COVID-19 damages the airway mucosa and blood vessels. It also causes an increase in the serum iron which is very important for the fungus to grow. Medications like steroids increase blood sugar. Broad-spectrum antibiotics not only wipe out the potentially pathogenic bacteria but also the protective commensals. Antifungals like Voriconazole inhibit Aspergillosis but Mucor remains unscathed and thrives due to lack of competition. Long-term ventilation reduces immunity and there are speculations of the fungus being transmitted by the humidifier water being given along with oxygen.
1) Stay indoors as much as possible
2) Regular exercises
3) Control of blood sugars
4) At home, the surroundings must be clean and free from dust and dampness
5) Maintain oral and nasal hygiene
6) While going out always wear an N-95 mask
7) Avoid construction areas, fields, grounds.
8) Soil and plants are the areas that abound with fungi. Hence better to avoid working with soil, gardening. If unavoidable, masks, rubber gloves, and boots are a must.
*****Post-Covid, during recovery, if a patient develops sinus headache, facial pain, stuffy nose, bloody nasal discharge, blackish discoloration over nose or palate, eye pain, swelling, diminished of vision or double vision, tooth pain, headache, seizures, drowsiness, limb weakness then immediate medical help must be attained.
Source : Indian Express