One of the most common terms we hear nowadays is ‘mucormycosis’ or ‘black fungus’. This infection, which has emerged as a deadly disease, has worried almost everyone. Perhaps the first thing we should ask ourselves is: is this illness truly severe, or are we unnecessarily scared?
Let’s look at the most common term trending now: ‘mucormycosis’ or ‘black fungus’. It is a severe and rare fungal infection. Earlier, it was known as zygomycosis. Exposure to the mucor mould is a leading cause of the disease. Typical habitats of the mould include the soil, plants, manure, and decaying fruits and vegetables. It can spread through inhalation, eating contaminated food, or exposing an open wound. Notably, direct human contact cannot transmit the disease. It most commonly infects the sinuses, the brain, and the lungs but is not limited to these organs. In some cases, it can be life-threatening to those with diabetes and weak immune systems.
Causes of Mucormycosis
Mucormycosis is a fungal disease. Fungi of the order Mucorales cause it. In most cases, Mucor – common bread moulds – are responsible for the infection. The species Rhizopus oryzae causes the deadliest illnesses. The fungal spores are present abundantly in the environment, on mouldy slices of bread or fruits. Inhaling these frequently can cause disease, but only in some people. Deposits of spores on the nose, sinuses, or lungs can infect one critically. They can also enter the skin through cuts or wounds or grow in the intestine if eaten. The fungus grows branch-like filaments upon the deposition of these spores. These invade the blood vessels, causing blood clots, which result in the death of surrounding tissues. Steroids are life-saving drugs for severe and critically ill COVID-19 patients. However, experts believe that they can also trigger the disease.
Types of Mucormycosis
Depending on the part of the body infected, mucormycosis may be of five types.
- Rhinocerebral: It infects the sinuses and the brain. People with poorly controlled diabetes and those with a kidney transplant commonly exhibit this illness.
- Pulmonary: It infects the lungs and commonly attacks people with cancer and those who have had an organ transplant.
- Gastrointestinal: It is most common among premature children and affects the stomach and the intestines. Antibiotics, surgery, and immunosuppressive medications put these children at risk.
- Cutaneous: It infects the skin. Burns and other forms of skin injury are common causes of this ailment.
- Disseminated (widespread): This classification signifies infection spread to different body organs through the blood. Other organs are less commonly affected.
Signs and Symptoms
Usually, the infection begins in the mouth or nose. It enters the central nervous system via the eyes. The signs and symptoms vary based upon the part of the body affected.
- When a sinus or brain is infected, one may have one-sided swelling on one’s face. One may also see congestion in the nose and sinus or a stuffy nose. Mild to high fever with swollen eyes are also common.
- When the lungs are affected, the eyes may appear to bulge. You may have a cough, chest pain and may also experience difficulty in breathing. Coughing blood has also been reported in some cases.
- When the gastrointestinal tract is involved, one may notice stomach ache, nausea, vomiting, and bleeding.
- When the skin is affected, it appears as a dusky red patch. The death of local tissues also creates a dark centre. Ulcers may also be present.
- The invasion of the disease into blood vessels can result in blood clots and tissue death surrounding it.
- Co-morbid patients are prone to disseminated (widespread) mucormycosis.
Treatment for Mucormycosis
Caregivers must take any person showing symptoms to a hospital. Doctors prescribe the drug Amphotericin B for the treatment of the disease. The drug is injected into the patient’s veins for 15 days. In 2015, the FDA approved another drug, Isavuconazole, sold under the brand name Cresemba. However, the regulatory body did this without a randomised control trial. An alternative for this drug is Possaconazole, sold under the brand name Noxafil. When medications fail, doctors may require surgical removal of the fungal balls. It is crucial to monitor the patient carefully for any signs of recurrence. Sometimes, more than one surgery is needed to fight against the infection. Removal of the nasal cavity or eye structures can be a blemish.
Preventive measures to this infection include:
- Wearing a mask in dusty areas.
- Avoiding direct contact with water-damaged buildings.
- Protecting skin, feet, and hands where there is exposure to soil or manure like gardening or other outdoor work.
- In high-risk groups like those receiving an organ transplant, doctors may give anti-fungal drugs as a preventive.
Mucormycosis and COVID
The second wave of COVID-19 wreaked havoc in India. Several doctors resorted to extensive immunosuppressive treatment for the disease. This led to several cases of what experts termed COVID-associated Mucormycosis. It affected several people and caused many deaths. Reports of this affection were generally rare but echoed from all corners of the country. Patients were diagnosed with mucormycosis around the nose, eyes, and brain. In most of the reported cases, the person infected from mucormycosis was also having diabetes. Observation presented most of the cases during hospitalisation. The disease requires early aggressive treatment, which is essential for the sufferer. Experts estimate that around 40-80% of people infected with any form of mucormycosis died from it. The part of the body infected and other underlying health conditions also impacted the morbidity rate.
Mucormycosis, or black fungus, has significantly affected the people in India. The fact that most COVID patients have diabetes further puts them at risk. And as we know, diabetes can worsen the problems created by the infection. On May 21, 2021, the Indian Council of Medical Research (ICMR) issued guidelines for recognising this disease. It also outlined measures for its treatment, along with its prevention. Hopefully, we shall get over this disease soon.