What is Mucormycosis, the Black Fungus?

Dr C Nithish

Mucormycosis (Black Fungus) is a rare infection. But now in present scenario, it is alarming the country, particularly Covid-19 recovered patients. Mucormycosis (Black Fungus) is caused by the group of moulds called Mucormycetes. Black Fungus is not a newly evolved fungus. It is present in our environment. When ever our immune system drops down rapily, we can't fight against the fungus, therefore it starts an infection.

Why post- Covid patients are more prone to Mucormycosis..?

Covid-19 is a viral disease and currently it is treated with blood thinners and steroids. These steroids are the culprits for Mucormycosis. Discriminate and irrational use of steroids is leading to this Mucormycosis. Dose tapering of steroids is to be done properly to overcome this infection. Water used in Humidifiers of Oxygen Cylinders is also reason for Mucormycosis.

Symptoms of Rinocerebral Mucormycosis :-

l One-sided facial swelling

l Headache

l Nasal or sinus congestion

l Black lesions on nasal bridge or upper inside of mouth that quickly become more severe

l Fever

Symptoms of pulmonary (lung) mucormycosis : - Fever, Cough, Chest Pain, Shortness of Breath.

Can Mucormycosis be treated?

Yes! Early detection of the infection can be treated with Anti-fungals like Liposomal Amphotericin-B injection or conventional Amphotericin-B Injection and Posaconazole tablets. As per studies Posaconazole is to be given 300 mg dose once a day or twice a day based on the severity.

Amphotericin-B is not compatible with normal saline. So it must be diluted with five per cent dextrose. All the health care professionals and nurses are to be trained about dilution and usage of Amphotericin-B. Before starting Amphotericin Therapy, we have to monitor renal functions and adjust the doses accordingly.

Voriconazole are not active against mucormycetes, As per studies there is some evidence to suggest that pre-exposure to Voriconazole may be associated with increased incidence of mucormycosis in some patients. So Voriconazole is not to be used in mucormycosis. In severe cases, surgical intervention is required.

Precautions to prevent Mucormycosis

l Mucormycosis is observed more in Covid patients with diabetes. So, diabetic patients should maintain normal sugar levels with regular use of medications, diet and lifestyle modifications.

l Home isolation Covid patients should not use steroids without doctor's advice.

l Steroids should not be used in early stages of Covid. They are to be used only when there is an evidence of Cytokinine Strom. There after, they have to be tapered properly on the advice of Critical Care Physician.

l Use clean water in humidifiers of oxygen cylinders.

l Maintain personal hygiene.

l Use mouthwashes containing Betadine, particularly in patients who are oral corticosteroids.

l Do not use the same face mask for longer days.

l Wash the cloth mask with one per cent hypochloride solution.

l For patients who are on oxygen support, healthcare professionals should sterilise the oxygen mask, nasal and oral region with 0.9 per cent normal saline.

Early detection of infection can save lives

Mucormycosis is fatal when it transmits from nasal cavity to CNS. Diagnosis of the infection in early stages is helpful to treat the infection with Anti-fungals, thus we can prevent the fungal transmission to Brain and we can protect the patient from loss of vision.

So, whenever you get symptoms like Severe headache, blurred vision, swollen cheeks, swelling of face. Don't take risk by being at home. Immediately rush to an ENT specialist.

(The author is Clinical Pharmacologist, Care Hospitals)