Doctors worried as Covid-19 triggers fungal infection among patients

Bengaluru: Doctors across the country fighting to contain Covid-19, they face another challenge -- the infections triggered by the dreaded virus.

Dr Jagadish Hiremath, Medical Director at Ace Suhas Multi-Speciality Hospital stated that Covid-19 triggering mucormycosis fungal infection is the new worry.

Explaining further, he said, "These infections are usually acquired when spores from the moulds are breathed in (inhaled) or, less commonly, enter the body through a cut in the skin.

Mucormycosis is an aggressive, life-threatening infection that occurs in people whose immune system doesn't function well (immune-compromised) including people with uncontrolled diabetes mellitus, low levels of neutrophils, a type of white blood cell (WBC) that helps the body fight off infection, and heal itself (neutropenia), or people whose immune system is being suppressed by medications (immune-suppression) as part of their treatment for Covid, blood cancer (hematological malignancy), hematopoietic stem cell transplantation, or solid-organ transplant."

However, the only respite is that the infection is not contagious. Prompt diagnosis and early treatment are critical. Treatment usually consists of antifungal medications and surgery.

Signs and Symptoms

Talking about its symptoms, Dr Hiremath said the most common presentation is a sinus infection (sinusitis) that is accompanied by nasal congestion, nasal discharge, and sinus pain.

"A fever and headache can also occur. If the infection spreads outside the sinuses, symptoms can include tissue loss (necrosis) of the roof of the mouth (palate), disintegration of thin wall of cartilage and bone (septum) that divides the nostrils (septum), swelling of the area around the nose (perinasal area), and redness (erythema) of the skin overlying the sinus and the eye socket (orbit). Sometimes, there is bluish discoloration of the skin near the sinuses or the eye socket due to a lack of oxygen (cyanosis).

Sometimes, blurry vision or double vision can develop. If unrecognized and untreated, significant tissue death (necrosis) can occur and the infection can significantly damage facial structures." he said.

The worrying factor about mucormycosis is that it can spread to the brain which can cause lethargy, seizures, slurred speech, partial paralysis, abnormalities of the nerves of the face and eyes (cranial neuropathies), a brain abscess, altered consciousness, and coma.

"When the infection spreads to the eye, there can be swelling due to fluid buildup around the eyes (periorbital edema), bulging or displacement of the eye (proptosis), vision loss, and potentially blindness. Some affected individuals experience paralysis or weakness of the muscles that move the eyes (ophthalmoplegia), making it difficult or painful to move the eyes," Hiremath offered insight about the infection.

Mucormycosis can affect the lungs (pulmonary mucormycosis), most often when the spores are breathed in and reach the respiratory system.

"Pulmonary mucormycosis is often a rapidly progressive disease characterized by fever and a cough that does produce any mucous (nonproductive cough). Less often, spitting or coughing up of blood (hemoptysis), chest pain, and difficulty breathing (dyspnea) will occur," he explains.

When mucormycosis affects the skin (cutaneous mucormycosis), affected individuals can develop a single, painful, hardened area of the skin and inflammation of the underlying tissue. Nearby skin may become reddened, warm, swollen and painful. Sometimes, open sores (ulcers) and blisters will form and tissue loss (necrosis) can occur with the affected tissue turning black. Affected individuals may have a fever.

Sometimes, the gastrointestinal system can be affected. "This most likely occurs when spores are breathed into the mouth and swallowed or contaminated food is eaten. Symptoms can include abdominal pain and vomiting of blood (hematemesis). Sometimes, severe pain in the bowels can occur because of a lack of blood flow (bowel infarction) and affected individuals can go into shock because of significant blood loss (hemorrhagic shock)," Dr Hiremath explained.