Dr Vikas Sharma & Chandan Thappa‘Black fungus’, also known as ‘Mucormycosis’, is a rare, but dangerous infection. Black fungus is caused by getting into contact with fungus spores in the environment. It can also form in the skin after the fungus enters through a cut, scrape, burn or another type of skin trauma. Fungi are found in soil and decaying organic materials such as leaves, compost heaps, rotting wood and so on. A form of mould called as ‘mucromycetes’ causes this fungal illness. It should be highlighted that people with health problems or who take medication that weaken the body’s capacity to fight infections are more likely to have this uncommon fungal illness. The symptoms of black fungus vary, depending on where it takes root, the US Center for Disease Control and Prevention (CDC) explains.* Sinuses and brain infection: One-sided facial swelling, headache, nasal or sinus congestion, black lesions on nasal bridge or upper inside of mouth that quickly become more severe.* Lungs infection: Fever, cough, chest pain, shortness of breath.* Skin infection: Blisters or ulcers, black skin around the infection, pain, warmth, excessive redness, swelling.* Gastrointestinal tract infection: Abdominal pain, nausea and vomiting, gastrointestinal bleeding.Who is vulnerable?People who fall into the following categories are morprone to develop black fungus infection:* Uncontrolled diabetes, diabetic ketoacidosis and diabetics taking steroids or tocilizumab.* Patients taking immune-suppressants or receiving anticancer treatment, as well as those suffering from a chronic debilitating illness.* Patients taking high doses of steroids or tocilizumab for an extended period.* Severe COVID cases.* Patients on oxygen who required nasal prongs, a mask or a ventilatory support.Why coronavirus patients are at risk?Mucormycosis can occur after COVID-19 infection, whether during the hospital stay or a few weeks after discharge. The COVID-19 generates a sudden change in the interior environment of the host for the fungus and the medical treatment administered unknowingly promotes fungal development. COVID-19 causes harm to the airway mucosa and blood vessels. With coronavirus and other conditions, a dangerous phenomenon called a “cytokine storm” can occur where the immune system goes into overdrive, damaging organs. So, doctors have been prescribing steroids to reduce the immune response. But it weakens body’s defences and increases sugar levels, which funguses thrive off.Preventive measures:* Cleaning and replacing humidifiers (for those using oxygen concentrators)* The humidifier bottle should be disinfected and refilled on a regular basis with normal saline.* Masks should be disinfected on a regular basis and should not be used for more than a week.* Steroid users should keep an eye on their blood sugar levels.* Mortified oxygen should be used during COVID-19 treatment.* Maintaining the cleanliness of their surroundings and practising good hygiene* Brushing and gargling daily is extremely beneficial.* If you have recovered from COVID, it is critical to wear masks to prevent the infection from entering the body.* Diabetic people must maintain control of their diabetes and check their blood glucose levels.* After infection with COVID-19, reduce use of steroids and immune-modulating drugs are to be discontinuedTreatment:* Surgical and medical therapy will be required for the majority of individuals. The patient is likely to die if the diseased region is not surgically debrided aggressively.* Medicines play an important role. Two main aims are sought simultaneously: antifungal drugs to slow or stop the fungal spread and drugs to treat debilitating underlying diseases.* Amphotericin B (initially intravenous) is the usual drug of choice for antifungal therapy.* Posaconazole or isavuconazole can treat mucormycosis.* Patients may even require an intravenous antifungal procedure lasting 4 -6 weeks.* Patients with underlying diseases like diabetes need to be in optimal control of their diabetes.(The authors are from Division of Biochemistry, SKUAST-J).
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