Mucormycosis in Covid-19 Pandemic
The nose and paranasal sinuses which are rich in blood supply are the first sites of infection
By Dr. Sashikanth Jonnalagadda
Consultant - ENT, Head and Neck Oncology
American Oncology Institute
Mucormycosis, also known as "black fungus," is a type of Opportunistic Fungal Infection. The fungus that causes this disease is commonly found in soil and damp areas and nasal cavities, but it does not usually cause disease.
This fungus gains the ability to invade blood vessels and tissues and cause disease in people with low immunity, such as diabetics, patients with prolonged steroid therapy, and other immune-compromised states. In the current Covid situation, steroids are being used rampantly and sometimes inadvertently in very high doses to counter the body’s immune response to Covid. Steroids raise sugar levels in both diabetics and non-diabetics. As a result, a suitable medium for these fungi to become invasive and cause severe disease is created.
The nose and paranasal sinuses which are rich in blood supply are the first sites of infection. If not checked in time the fungus spreads to the eyes and brain very rapidly.
The presence of black or bloody nasal discharge, discomfort and swelling around the eyes, or facial pain are all signs of fungus invasion. It can further spread to surrounding tissues such as the hard palate, throat, lungs, and skin around the nose, but more importantly, it can also spread to the eyes, causing blindness, and to the brain, causing extreme headaches and death.
If you experience any of the above symptoms, consult an ENT surgeon at the earliest. The patient needs to undergo a nasal endoscopy, and if tissue invasion is detected, such as red or black discoloration of the nasal lining, a biopsy is taken to detect fungus, followed by a CT scan or an MRI to determine the degree of the fungus's spread.
Once the diagnosis is confirmed it needs to be treated by Surgery to thoroughly remove all the diseased tissue, followed by 4-6 weeks of medical treatment with Amphotericin-B. Oral antifungals like Posaconazole and Isavuconazole are also used as an alternative.
The prognosis of this deadly disease is very bad and only 50% of patients have a complete recovery without long-standing complications. As a result, steroids must be used in the right dosage, diabetics being treated with steroids must keep their sugar levels under strict control, and early detection and consulting your doctor in case of any suspicious symptoms is of utmost importance to overcome the deadly ‘Black fungus’.