What is Black Fungus?

 

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Even as India reels under the Coronavirus onslaught, another menace has reared its head. It is deadly and not easy to get rid of. It can disfigure the human face and destroy faculties. In common parlance, it is called ‘Black Fungus’. Its scientific name is ‘mucormycosis’ and is supposed to be a rare disease. But it does not appear to be all that rare now because it threatens a large section of India’s population suffering from Coronavirus. According to experts, there used to be just one case of black fungus in several months. But, of late, the frequency has risen to more than 30 cases a month in some places, especially Bengaluru. However, experts tell us that it cannot be described as a major outbreak yet.  

However, there has been a definite rise in black fungus cases in Gujarat, Telangana, Karnataka, Delhi and Maharashtra. According to an Australian website ‘ABC.net.au’, even before the pandemic, this infection disproportionately affected Indian patients. The number of patients infected with black fungus is about seventy times higher than the rest of the world. The reason for this is the hot and humid climate that nurtures these pathogens. COVID-19 has only made things worse for potential victims of black fungus. Mucormycosis is caused by a group of moulds called mucoromycetes, found in soil and in decaying vegetation. They then enter water and air through various means. Since the germ proliferates in the environment, the chances of an increase in the number of cases are quite high in India.

The viruses, bacteria and disease-causing micro-organisms, called mucoromycetes, are present in the environment and attack those who have low immunity levels. Vulnerable groups include people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. These include COVID-19 patients, diabetics, cancer patients, as well as those who have had an organ transplant. Even those patients who have to be admitted to hospitals for a longish duration are vulnerable to the black fungus infection. This fungus can also occur in cases where the water used in the oxygen humidifier is not sterilized.

The infected patient’s skin turns black with what appear to be blisters and ulcers. People can lose their sight if the eye socket becomes infected, and the infection can spread to the brain, causing seizures, coma and comprehension difficulties. People can get sick if they breathe in spores from the environment. Even stale and polluted eatables can contain such spores. These can also enter the body through a cut or broken skin.

Are there any specific symptoms of this disease? The National COVID-19 Task Force has listed certain warning signs, which include pain and redness around the eyes or nose, fever, headache, coughing, shortness of breath, bloody vomits, and altered mental status. Further, infection with mucoromycetes should be suspected when one or more of the following occur:

* Sinusitis — nasal blockade or congestion, black or bloody nasal discharge;
* Local pain on the cheekbone, one-sided facial pain, toothache, numbness or swelling;
* Blackish discolouration over the bridge of nose/palate;
* Loosening of teeth, jaw involvement;
* Blurred or double vision with pain;
* Thrombosis (swelling and pain due to blood clot formation), necrosis (premature death of cells in a body caused by injury or disease, and results in inflammation. Gangrene is an example of necrosis.), skin wound that does not heal easily;
* Chest pain, pleural effusion (a  pleural effusion is an unusual amount of fluid around the lung), worsening of respiratory symptoms.

However, the above symptoms on their own cannot be definitively taken as black fungus infection. It is highly advisable to seek expert investigation to confirm or rule out the fungal infection.

According to the Indian Council of Medical Research Guidelines for Black Fungus, “Mucormycosis, if uncared for, may turn fatal. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air”.

Major risk factors for this disease include uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, malignancy, and voriconazole therapy. To prevent the disease, blood glucose level should be monitored after a Covid patient is discharged from hospital, and also in diabetic patients; steroids should be used judiciously; clean sterile water should be used in humidifiers during oxygen therapy, and antibiotics and antifungal medicines should be used strictly according to the doctor’s prescription.

Treatment of Black Fungus

Management of Covid patients with mucormycosis requires a multi-disciplinary approach. It involves microbiologists, internal medicine specialists, neurologists, eye and ENT specialists, dentists, surgeons and others.

It is essential to control diabetes, discontinue immunomodulating drugs, reduce steroids, and resort to extensive surgical debridement to remove all necrotic materials.

Medical treatment includes installing peripherally inserted central catheter for draining the bladder, maintaining adequate systemic hydration, infusion of normal saline intravenously and anti-fungal therapy for at least six weeks. The patient should be monitored clinically to detect disease progression. Doctors also resort to judicious use of steroids and immunosuppressive drugs especially in elderly, immunocompromised, cancer and diabetic patients with Covid.

If the prescribed therapy does not work, or if the infection has caused irretrievable damage, surgery becomes the only way out. This can lead to loss of the upper jaw and sometimes even an eye, which can cause psychological trauma to the patient. This is where a psychologist can play an important role by helping the patient to cope with the loss of jaw which can cause difficulty in chewing and swallowing. Moreover, disfiguring the face can cause a loss of self-esteem. Doctors need to assure the patient that the loss of the eye or upper jaw can be replaced with appropriate artificial substitutes. While prosthetic replacement of the missing facial structures can commence once the patient stabilises after surgery, it is important to reassure him or her about the availability of such interventions. Never should the patients be left to panic with the sudden unforeseen loss which can increase their post-Covid stress.

Needless to say, prevention is always better than cure. So, how do we prevent falling prey to this deadly infection? Here are some precautions prescribed by experts.

·      Use masks if you are visiting dusty construction sites. Wear shoes, long trousers, long-sleeved shirts and gloves while gardening.

·      Maintain personal hygiene.

• Keep a check on blood glucose levels after getting discharged from a COVID-19 hospital. 
• Keep a check on the timing of taking steroids and their dosage.
• Keep water clean for humidifiers while undergoing oxygen therapy.
• Use antibiotics or antifungals under strict medical supervision.

• Make sure to keep yourself well-covered while handling soil, moss or manure while farming or gardening.

As long as we take proper precautions, we can stay safe from the black fungus infection. Do remember, our body has a powerful immune system, which needs to be regularly reinforced by leading a vigorous lifestyle.

Stay safe, stay healthy.