Black Fungus or Mucormycosis is a great risk

Dr. Girish Anand M S, Consultant - ENT Surgery, Aster CMI Hospital, Bangalore, Karnataka, India

There has been a significant rise of fungal infections in COVID-19 patients from India. Mucormycosis or Black Fungus is an opportunistic infection, in which spores of the fungus take hold of tissues in immunocompromised patients, such as those who have contracted COVID-19 or are on immunosuppressants such as steroids. The Union Health Ministry of India recently declared Mucormycosis as an epidemic in India. 

Mucormycosis is a serious infection caused by group of molds called Mucormycetes. Rhinocerebral mucormycosis (black fungus) is an infection that affects the sinuses and can also spread to the brain. This fungus usually resides in the nasal mucosa and then germinates to spread from the nose into the eye and brain in diabetics, immunocompromised patients and people who have had renal transplant. Transmission generally occurs through inhalation, inoculation, or ingestion of the spores. These fungal spores are mostly present in the environment particularly in soil and on inhalation and in people with weaker immune system it can spread through bandages, linens, water leaks, poor air filtration, nonsterile instruments, and open wounds. 

The fungus damages cells and nerves and cuts off blood supply as it spreads. The lack of blood supply turns tissue black, earning the disease the misnomer “black fungus”. In the recent times, there is a significant rise in the cases of Mucormycosis in COVID and post COVID patients. The probable causes would be increased usage of steroids in the treatment of COVID, inadequate monitoring of blood sugar level, altered innate immunity, immune dysregulation, and invasion of the vessels and formation of clots.

Given a large number of COVID 19 cases across the India, Mucormycosis is something that should be taken seriously and both patients and caregivers should be made aware of it.

Symptoms & Signs of Mucormycosis: Recognizing the below symptoms early is the surest way to diagnose and treat the disease.

  • Sinus headache
  • Facial pain
  • Stuffy nose
  • Blood nasal discharge
  • Blurring of vision
  • Double vision
  • Dental pain or loosening of teeth 
  • Facial swelling
  • Facial skin coloration
  • Ptosis (closure of eyelid)
  • Proptosis (swelling of the eyeballs) 
  • Restricted eye movements
  • Palatal blackish discoloration
  • Brownish discharge from the nose

Detection and Examination for Mucormycosis:

  • Complete blood count
  • Blood sugar test
  • Renal function test
  • Deep nasal swab- KOH staining to detect the fungus
  • Nasal endoscopy and biopsy
  • MRI gadolinium and,
  • CT scan of the Nose and PNS 

Prevention of Mucormycosis in high-risk COVID patients would include:

  • Avoiding areas with a lot of dust, as the fungus spores exist in dust and old construction material 
  • Ensuring the patient always wears a good mask
  • Taking extreme contact and droplet precautions and maintain strict hand hygiene. Spores spread through droplets and coughs and can infect anybody with low immunity.
  • Ensuring strict control of blood sugar. COVID-19 and steroids used as treatment, push up the sugar level in the body. This elevated sugar level is food for the fungus to grow.
  • Avoid using steroids for home isolation patients especially when you cannot monitor blood sugar levels
  • Maintain nasal hygiene of patients and wash it through saline daily. This clears out dust particles and fungus spores.
  • Maintaining hygiene of the equipment used for oxygenation - nasal prongs, nasal canula, masks for ventilation. As equipment’s not used for long may have dust particles along with fungal spores.
  • Linen can carry fungal spores too and therefore should be cleaned daily thoroughly 
  • Keeping a close watch for early symptoms and reporting to an ENT surgeon 

If symptoms are ignored in the early stages, the consequences can be very serious. In advanced stages the fungus can affect the sinus bones leading to their removal, if it enters the eye, the eyeball will have to be removed, and further if it affects the brain, it will be fatal. Hence it is very important for its early detection, diagnosis, and prompt institution of treatment.