Black fungus in Covid patients– Awareness is the key 

The various manifestation of Covid 19 virus has further raised concerns among public. Sometimes, this virus can affect an individual without showing symptoms and in few cases, people may face severe health complications like high fever, breathing problem, drop in oxygen saturation and even pneumonia. Mucormycosis or commonly called as black fungus is one such condition due to Covid 19 which in rising alarmingly among patients who have tested positive for the virus and recovered from it.  

There has been a steady increase in the number of black fungus cases in the last few days. If this condition is not detected and treated at an early stage, it can rapidly spread to the other parts of the body like eyes and brain and cause loss of vision and at times even fatal. Moreover, the reduced availability of antifungal medicines like Amphotericin –B has further complicated the situation. 

Reason for the spike in numbers
People suffering from Covid 19 tend to immune system that is compromised. Covid positive patients who are critically ill or have severe symptoms are given steroids which is the lifesaving treatment for them. Steroids reduce inflammation in the lungs for Covid-19 patients and appear to help stop some of the damage the infection can create to the body. 

Covid 19 patients who are taking steroids as part of their treatment are particularly at risk of developing black fungus because steroids further suppress the immune system. A combination of Covid 19, uncontrolled diabetes or other comorbid conditions and steroids adds fuel to the fire and increases the chances for black fungus. Therefore, it is important to avoid taking any over the counter the medications without prescription and steroids need to be used judiciously. 

Mucormycosis – the black fungus

Mucormycosis is a rare fungal infection that affects sinuses, brain and lungs. A group of moulds called mucormyetes which are naturally present in the environment causes this. These fungi are present in soil, decaying leaves, compost piles and animal dung. Though, one can contract this by breathing the mould spores in the air, the risk increases among with weakened immunity system. 
Mucormycosis can cause severe complications in people who have uncontrolled diabetes or individuals who are severely immunocompromised like cancer patients or people with reduced immunity.
Mucormycosis is a rare and non-contagious infection. However, it can be debilitating or fatal if it is not diagnosed and treated in time. 
Warning signs and symptoms to watch out:
•    One-side facial pain or numbness
•    Blackish discoloration over the bridge of the nose or palate
•    Toothache
•    Blurred or double vision with pain
•    Skin lesion 
•    Thrombosis 
•    Chest pain 
•    Worsening respiratory symptoms 
•    Altered mental status
Who have to be more cautious?

Mucormycosis mainly affects individuals who have low immunity, especially patients who have had a prolonged admission in the ICU. Recently, this infection is mostly seen in people who have tested positive for Covid 19 and on steroids coupled with other comorbidities like uncontrolled diabetes, cancer, kidney failure, heart failure etc.  Age and high ferritin levels in the blood can also add to the complication.  

Black fungus generally does not pose threat to individuals who have functional immune system. 

How does it spread?

Though, black fungus is not transmissible, it can pose danger to the affected person as it spreads rapidly throughout the body. If left untreated, it can spread to brain and lungs causing complications like brain infection, paralysis, seizure, pneumonia and in severe cases can be fatal. 

As black fungus is  a rare condition, the first wave of Covid 19 brought focus on this and emphasised on the immediate treatment to curb the spread of fungus to other parts of the body. However, in the second wave there is sudden spike in cases and many states now have been reporting mucormycois cases. 

Is mucormycosis treatable?
Mucormycosis can be treated with surgical intervention and using antifungal medications. Along with this, managing the diabetes, discontinuing the immunomodulating drugs and reducing the intake of steroids also helps. 
Prevention of mucormycosis
In general self-care measures are the best way to avoid this infection. Especially people with weakened immune system need to be careful of their condition and the medicine intake. Safeguarding themselves from the Covid infection is more important. Below are the few tips to prevent mucormycosis:. 
•    Follow Covid 19 protocols of wearing masks, washing hands and maintaining social distancing 
•    Keep diabetes under control
•    Monitor blood glucose level post-Covid-19 discharge 
•    Use steroid judiciously – correct timing, correct dose and duration
•    Use clean, sterile water for humidifiers during oxygen therapy
•    Use antibiotics/antifungals medicines judiciously
•    Do not miss warning signs and symptoms particularly in the context of immunosuppression and/or Covid-19 patients on immunomodulators

Taking precautions is the best way to keep away from infections. However, even if an individual contracts the infection, identifying the symptoms and taking the immediate medical help always aids in treating it effectively. 
 

Authored by:

Dr.Jyotirmay S Hegde, Consultant ENT & Skullbase Surgeon, Columbia Asia Hospital, Whitefield (A unit of Manipal Hospitals)