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The Curse of Black Fungus!

/ All, Brain, General / By

The pandemic era of COVID has opened arenas for multiple epidemics; the epidemic of black fungus adds to the misery. All over the world, people are losing battle to COVID infection and if conquered, another battle to be fought – the battle with black fungus.

Black Fungus as better known as Mucormycosis in scientific community has been a rare fungal disease in pre COVID times. It has always been dangerous. This is caused by a group of molds. The organisms implicated are Rhizopus, Mucor, Rhizomucor, Syncephalastrum species, Cunninghamella bertholletiae, Apophysomyces species, and Lichtheimia (formerly Absidia) species.

Red lines Show the intimate relation between sinuses, orbit and brain

TYPES OF MUCORMYCOSIS

The types of disease and symptoms caused by this depend upon the organ system affected:

  1. Rhinocerebral (Sinus and brain) Mucormycosis: Paranasal sinuses, eye sockets and brain are closely placed in the head. Infecting one of these areas lead to rapid spread of the disease to another area. Usually people with uncontrolled diabetes and renal transplant are affected by this type of disease. These patients come with:
    1. Facial swelling
    1. Headache
    1. Nasal or sinus congestion
    1. Black lesions on nasal bridge
    1. Fever
  • Pulmonary (lung) Mucormycosis: patients with cancer and other immunosuppressed status like in stem cell transplants and solid organ transplant develop this type of disease. These patients present with:
    • Fever
    • Cough
    • Chest pain
    • Shortness of breath
  • Gastrointestinal Mucormycosis: this has been more common among youngsters and premature infants, who had been on antibiotics .
  • Cutaneous (skin) Mucormycosis: usually after burns or surgery or any ulcer which refuses to heal due to various factors lead to development of this type of disease. These patients present with:
    • Blisters
    • Ulcers
    • Swelling around wound
  • Disseminated Mucormycosis: This happens when the disease in widespread. Usually central nervous system is affected more than other organs. These patients are already sick and it is difficult to diagnose in such patients. These patients usually have unexplained fever, multiorgan dysfunction and unconsciousness.

WHO IS AT RISK?

This disease is more often seen in the following category of patients:

  1. Uncontrolled diabetics
  2. Cancer patients
  3. Immune suppressed patients like transplant recipients
  4. Long steroid use
  5. Skin injury
  6. Premature born babies

The mucormycosis spreads through spores of the fungus. These spores are always in our air but normal circumstances, this does not develop due to robust immune system. Any time when the immunity is suppressed to critically low level and for a long time, these spores start developing opportunistically and disease is caused.

THE DISEASE IS NOT CONTAGIOUS

Avoidance of the disease is important.

  1. Use N95 masks
  2. Avoid construction sites and dust
  3. Avoid water damages areas
  4. Maintain dry environment at house.
  5. Clean humid areas frequently
  6. Cover feet while going in wet areas
  7. Wear gloves while handling soil and manure
  8. Wash and dry skin after any contaminated place contact.

Diagnosis requires biopsy and culture of the tissue. At times CT scan of chest may be required.

Treatment requires hygiene, antifungal drugs and surgical removal of infected tissue. Drugs used are amphotericin B, isavuconazole, posaconazole. Other drugs like voriconazole, fluconazole and itraconazole have no role in treatment.

HOW BAD IS THE DISEASE?

Mucormycosis is a life-threatening infection. The death rate varies depending on underlying patient condition, type of fungus, and body site affected (for example, the mortality rate was 46% among people with sinus infections, 76% for pulmonary infections, and 96% for disseminated mucormycosis).

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