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Mucormycosis or Black Fungus is a rare infection with a high rate of mortality. Experts believe that it was possibly first described in 1855 by Friedrich Küchenmeister, a German physician, and it has been reported in several natural disasters across the world, such as the Missouri Tornado (2011) and the Indian Ocean Tsunami (2004). It is, thus, not an unknown disease. Recently, it has been making rounds and creating panic, as it is affecting a noticeable number of COVID-19 patients. So, what is it exactly, and can it be prevented? Read on to find out.
What Is Mucormycosis?
Mucormycosis is a rare but serious fungal infection caused by a group of moulds called mucormycetes that live in the environment. Those who come in contact with the fungal spores may contract the infection. However, the risks of contraction and infection are higher for those with weak or compromised immunity, chronic health issues, and those who are on immunosuppressants. Depending on the part of the human body it affects, mucormycosis could lead to rhinocerebral (sinus and brain) mucormycosis, pulmonary (lung) mucormycosis, or gastrointestinal, cutaneous (skin), and disseminated mucormycosis (occurs when the infection spreads through the bloodstream).
What Causes Mucormycosis?
Mucormycosis is caused by the spores of mucormycetes, which can be easily found in the environment. These moulds occur in decaying organic matter, such as rotten wood, leaves, soil, and compost.
While the mucormycete moulds can be found everywhere, it is mostly people with weakened immune systems, pre-existing health conditions, and those who have undergone organ transplants who are at risk of contracting the infection.
Why Does Mucormycosis Occur in COVID-19 Patients?
Although mucormycosis is a rare disease, it could occur in patients whose immune system is compromised or suppressed by COVID-19. One of the likely reasons for this is the inappropriate dosages of steroids, which, while being effective in reducing inflammation in the patients can, in turn, affect the body’s ability to fight infections, thus increasing the risk of mucormycosis.
COVID-19 patients with diabetes are also at a higher risk of contracting this infection, as the prescribed steroids can lead to uncontrolled blood sugar. High blood sugar causes acidic blood, which is the kind of environment in which the mucormycete moulds thrive.
Some experts also believe that the use of contaminated oxygen cylinders could be another reason for a rise in the number of mucormycosis cases in patients undergoing treatment for COVID-19.
Symptoms of Mucormycosis
The symptoms of mucormycosis depend on the affected part of the body.
- Rhinocerebral Mucormycosis – The patient will experience nasal and sinus congestion, headache, black lesions on the bridge of the nose or the upper side of the inside of the mouth, fever, and facial swelling (mostly one-sided facial swelling).
- Pulmonary Mucormycosis – The patient is likely to experience shortness of breath, cough, fever, and chest pain.
- Gastrointestinal Mucormycosis – The patient is likely to have abdominal pain, nausea, vomiting, and gastrointestinal bleeding.
- Disseminated Mucormycosis – It could be difficult to diagnose disseminated mucormycosis, as it occurs in patients with chronic health conditions. The symptoms of the existing conditions may throw the diagnosis off track, and it could be difficult to confirm the symptoms of disseminated mucormycosis. Therefore, one must consult an expert who will conduct a thorough study of any pre-existing health conditions and ongoing treatments to confirm disseminated mucormycosis.
Complications of Mucormycosis
Mucormycosis, if not treated at the right time, could lead to health complications, such as blindness, nerve damage, blood clots, or blocked blood vessels. It is a fatal infection with a mortality rate of 50%.
How Is It Diagnosed?
The symptoms can help diagnose rhinocerebral, pulmonary, and gastrointestinal mucormycosis. However, to confirm or rule out the infection, the doctor would ask you to get fluid sample tests done in a pathological lab. A tissue biopsy may also be prescribed to confirm the infection. A CT or an MRI scan may also be required to know how much the infection has spread, to decide further course of action.
Treatment of Mucormycosis
Once the infection is diagnosed, the doctor will prescribe antifungal medication right away to stop and destroy the growth of the fungus inside the body and control the infection. Surgical debridement is necessary for cutting away all infected tissue. Removing infected tissue prevents the infection from spreading further.
The medication can be intravenous or in the form of pills, depending on the severity of the condition. Amphotericin B is the drug of choice. In addition, Isavuconazole and Posaconazole may be needed. If the patient has underlying diseases like diabetes, it must also be optimally controlled.
The patient must stick to the prescribed dosages and immediately report any side effects, such as heartburn, breathing issues, or pain in the stomach, to their doctor to get the medication altered to suit their requirement.
Life After the Surgery
The mortality rate of mucormycosis is said to be around 50%. If prompt treatment is provided, one can recover with the help of medication and surgery. Surgical procedures, as mentioned above, will require the affected tissue or body part to be removed to stop the infection from spreading. It will lead to a tremendous change in the patient’s course of life. For example, patients suffering from rhinocerebral mucormycosis could lose their vision during the treatment; some might have to get the affected eyes removed.
Loss of an organ and the inability to perform regular tasks due to such a major life event can also affect a person’s mental health. They are, at some point, bound to have feelings of helplessness and anxiety. One must, therefore, be prepared to fight these challenges and focus on the positives.
Can It Be Prevented?
Prevention of mucormycosis is difficult, as the fungal spores occur in the environment, and one cannot foresee if they will be exposed to them or not. You may, however, try the following things to prevent mucormycosis, but you must remember that these tips do not guarantee complete protection from the fungus.
- Avoid any direct contact with soil, as the moulds in the soil can cause cutaneous mucormycosis. Ensure you wear gloves, shoes, long pants, and full-sleeved shirts to reduce any chances of your skin being exposed to the soil. Also, wash your hands thoroughly with soap and water immediately after working with soil.
- Avoid any contact with contaminated water, especially flood water or water in unused/contaminated tanks.
- Stay away from dusty areas like construction sites, as the dust may carry the mucormycetes moulds. In case you live in a dusty area, it is imperative for you to wear a good mask, preferably an N95 mask.
- Do not ignore any signs and symptoms. Sinus congestion may not necessarily be a common cold. Seek medical aid immediately to diagnose the issue.
- Keep your immunity up, as that’s the only way to fight any infection. Therefore, consume fresh fruits and vegetables, and exercise at least 3-4 times a week for about 30 minutes.
- Prevent COVID-19 by wearing masks and social distancing.
To sum up, mucormycosis is not an unknown condition, but it is making us hit the panic button, as it is affecting us in the middle of the pandemic and is associated with it. It is always a good idea to keep yourself informed by reading about such conditions, and you must seek immediate medical attention if you notice any of the symptoms mentioned in this article.
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