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While COVID-19 cases are on its extreme across country with a fear of its third wave, the cases of new infection, Black fungus (Mucormycosis), has been reported from many hospitals affecting Covid-19 patients, causing complications. As the exact numbers are not available but its continuous rise has been seen in states like Delhi, Gujarat and Maharashtra. 

What is Mucormycosis? 

Mucormycosis is a rare fungal infection, caused by a group of moulds called mucormycetes, found naturally in air and soil, create complications especially in a people who are ill and inhaled fungal spores present in air droplets and dust. Ones inhaled, it spreads into sinus cavities, lungs and chest cavities. It is considered to be a big and serious threat and according to the experts, those who are using indiscriminate steroid and having pre-existing comorbidities like diabetes or cancer, may have higher risk of getting infected from mucormycosis.

According to Dr Ronak Shukla, LG Hospital, Ahmedabad, the disease progresses rapidly, which attacks and kills the "blood vessels and live tissues", turning them all black — and so named as 'black fungus.

According to Tobias Hohl, chief of infectious disease service, New York’s Memorial Sloan Kettering Cancer Center, Black fungus does not affect those having normal immune system and infection from it, depends on person’s health condition. According to the experts, there is 50% chance of dying from this disease, if infection reaches to the brain.

Why rare black Fungus infecting Covid-19 patients ?

Though the reason is unclear, why black fungus is affecting Covid-19 patients, but as per health experts, the reason may be, the over-use of steroids in Covid-19 patients. While it  reduces inflammation in the lungs but its overuse also lowered the immunity and increased the sugar level in the blood, which lead the patients susceptible to infection. 

Signs and symptoms

Many signs and symptoms have been recognised, which vary from person to person. The symptoms can be from mild to severe. Among them, the most characteristic feature is loosening of teeth. blackening and swelling inside the mouth, palate, teeth or nose , fever, impairment of sensory and vital organs, abnormal black discharge or crust or blood from the nose. Other includes:

Unbearable headache- As it attacks nerves and sinus cavities, it leads to persistent pain and headaches.

Vision impairment- Another warning sign, causing vision distortion, hazy or poor vision and swelling in the eyes.

Swelling in the cheeks or parts of the face- Swelling, local pain on the cheekbone, one-sided facial pain or numbness or tingling effect, multiple lesions, difficulty in chewing or opening mouth, like symptoms are also seen in this infection.

Altered mental state and confusion- Doctors also found some critical symptoms in patients infected with this fungus like delirium, memory loss, neurological impairment, the altered mental state and advised for proper attention. 

Facial distortion or swelling- This is the primary sign of the infection, which result in the growth of black patches around the eyes and nose on severity.  Facial swelling (especially nose, cheek, around the eye) or black discolouration, hardening, and pain on touch are also the symptoms that needs to take care of it. 

What Treatment is Needed ?

Early diagnosis can be a lifesaving but this infection is extremely challenging to treat, even if diagnosed early. Doctors prescribed to those patients :

• Antifungal treatment- like liposomal Amphotericin B injections for at least 10 days to several weeks after diagnosis. 
• Surgery- Sometimes surgical intervention is also required.
• Endoscopy- This is done through nasal cavity to remove infected tissues.
• Eye or Jaw removal- This is done to stop the spread of disease, as it can spread to the eyes or the jawbone in just three days. In such cases, the only way to stop the spread is to remove the infected eye or jawbone surgically.

How to Protect Yourself From Black Fungus

According to Advisory by ICMR (Indian Council of Medical Research) and AIIMS guidelines, Black fungus are affecting those people who are on medication for longer duration or having diabetes that reduces their ability to fight against environmental pathogens but this can be prevented by following some factors like:

• Immediate consultation with an ENT doctor, ophthalmologist, or the doctor who is treating the patient in case of any abnormal findings
• Regular treatment and follow-up. Strict control and monitoring of blood sugar in diabetics
• Regular medications and follow-up for other comorbidities
• Use masks while visiting any dusty construction sites
• Wear shoes and gloves while handling soil (gardening), moss or manure
• Wear long sleeve shirts and long trousers
• Maintain personal hygiene, including thorough scrub bath and use clean, sterile water for humidifiers during oxygen therapy
• Use steroid judiciously i.e. correct timing, correct dose and duration and no self-medication
• Use antibiotics/antifungals as prescribed
• Use Antifungal Therapy as recommended

The Bottom Line

As of now the cases from this fungal infection are small but brought new challenges for patients and healthcare as well. Recently, ICMR, issued an advisory for the screening, management and diagnosis of mucormycosis in the time of COVID-19. It is advised by public health experts to maintain hygiene in the hospital especially for equipment that dispenses oxygen. It is also advised to the hospitals to use steroids only on recommendation and strictly monitor sugar level as well.

The guidelines have been issued by ICMR that, it not only affect a COVID patients in their recovery, but if left untreated, it could become extremely fatal.