Black Fungus: What you Should know

With the world going through the grasp of the novel coronavirus, we now need to deal with another
disease named ‘Black fungus’ infection, also known as mucormycosis.

What is a fungus?

These are organisms different from the plants and animal kingdoms. They are ubiquitous and persist

in the soil, plants, decomposing organic matter, water, air, damp places, and humans and animals.
They very much play a significant role in our ecosystem, bacteria, by degrading organic matter into
simpler forms for the consumption of plants.

What types of infection do these fungi cause?

Usually, some fungi don’t cause any infections in humans but can cause illness in people with
reduced immune systems, known as opportunistic infections.

Some common types of fungal infections comprise skin infections like ringworm, nail infections,
deeper cutaneous infections following trauma. The fungi can also affect the digestive systems and
renal systems. It may cause a nasty disease, resulting in the entry of fungus into the bloodstream.

Who is susceptible to fungal infections?

People with reduced immune response are more receptive to infection. Ailments that reduce our
immunity include:

-Diabetes: High blood sugars with an acidic environment, as seen in diabetic ketoacidosis, boost the
swift growth of these organisms. Diabetes is also linked with reduced immune response.

-Steroid medicine increases blood sugar levels and decreases the immunity power of the body.

-Blood malignancies, which also results in the flawed immune system

-Patients on immunosuppressants as seen with organ recipients and are haematologic somatic cell
recipients.

-Patients with excess iron or using deferoxamine

-Injury, burns, and malnourished people.

Why is it happening in COVID 19 patients?

Mucormycosis can happen after taking the vaccination, either during the hospital stay for numerous
days to a couple of weeks after discharge.

“The COVID-19 causes favorable alteration in the internal milieu of the host for the fungus and the
medical treatment given, unwittingly also abets fungal growth. COVID-19 harms the airway
mucosa and blood vessels. It also induces an increase in serum iron which is very vital for the
fungus to grow. Medications like steroids increase the blood sugar level. Broad-spectrum antibiotics
not only wipe out the possibly pathogenic bacteria but also the protective commensals.”
Antifungals like Voriconazole repress Aspergillosis, but Mucor prevails unscathed and thrives
thanks to lack of competition. However, ventilation lowers the immunity level, and there are
considerations of the fungus being transmitted by the humidifier water, which is given alongside
oxygen.

What are the clinical characteristics of mucormycosis infection? How do we cure them?

Blocked nose, bleeding, discharge from the nose are some symptoms of mucormycosis. On
endoscopic visualization of the cavity, an unmistakable black eschar (slough or dead tissue) coated
masses will be present, which provides away the diagnosis. As the disease progresses, the palate
could also be destroyed as an outsized black necrotic mass could also be seen on opening the
mouth. When the orbit is involved, there’ll be proptosis (protrusion of eyeball) and loss of eyeball
movements with consequent diplopia. Eye pain, redness with blindness can follow. If the brain is
invaded thanks to vessel blockage, there’ll be strokes, hemorrhages, and even death. Finally,
patients go through headaches, drowsiness, limb weakness, seizures, and in the worst-case scenario,
death.

How is ROCM cured?

It is a multi-pronged method, and time is of the essence here. After processing the clinical and
radiological analysis, endoscopic evaluation of the nasal cavity can confirm a fungal lesion.
Immediate surgical debulking is a must. The operation can be radical and disfiguring but is
acceptable regarding the existential crisis of leaving behind any residual tissue. The entire cavity
must be scoured, and every fungal, necrotic tissue must be removed, and the orbit is involved.

Surgeries as drastic as exenteration of the eye socket contents are required. Intracranial
decompression may be needed if the infection has spread to the brain. Surgical intercession should
be initiated a couple of hours after the diagnosis.

Posaconazole medicines/ suspension and intravenous forms are available and are used instead of
amphotericin if the patient does not tolerate the latter. Under many days of intravenous observation
and medication depending on the response, the patient is put on oral posaconazole sustained-release
medicines for many months. The use of Isavuconazole medicine gains recognition. The use of drugs
after clinical and radiological clearance of the disease is a must.

Throughout the treatment, judicious use of steroids (keeping blood glucose levels under control),
antibiotics, and other antifungal drugs become vital.

Are these infections deadly?

These infections are very harmful, and if not treated, many will not make it. The mortality ranges
between 25 to 90%. If the infection spreads into the brain, mortality is very high. Hence much
attention is given to early diagnosis and prompt institution of treatment.

How to prevent the occurrence of ROCM?

As you know, prevention is usually better than cure.
In hospital:

-Keeping good hygiene and cleanliness is a must. Regular with mouthwash, povidone-iodine
gargles should be done.

-While oxygen is supplied, water for humidification needs to be sterile, and there should be no
leakage from the humidifier.

-The use of steroids should be reduced to not more than necessary with strict blood glucose checks.

-Unnecessary use of broad-spectrum antibiotics, antifungals should not do as this eliminates the
normal commensal flora resulting in the growth of undesired organisms due to lack of competition.
Once discharged:

Stay indoors as much as possible. Perform regular exercises. Check and control sugar levels. At
home, the surroundings should be clean and free from dust and dampness. Maintain oral and nasal
cleanliness. While going outwear an N-95 mask. Avoid construction areas, fields, grounds. Soil and
plants are the areas that swarm with fungi. Therefore, it is better to avoid working with soil,
gardening. If inevitable, masks, rubber gloves, and boots are a must.