Know everything about Black Fungus

Coronavirus related Mucormycosis, usually alluded to as Black Fungus, is an aggressive fungal infection. This fungal infection happens exposure from a fungi called Mucormycetes. These fungi usually happen in the climate, especially in leaves, soil, compost, and animal waste in the form of dung. In excess of 11,000 cases of Black Fungal infection accounted from various parts of India, it has forced State Governments to announce it as an epidemic. Let us know everything about Black Fungus.

Causes and Symptoms of Black Fungus

Mucormycetes have the ability to enter the human body through breathing, inhalation and exposure of wounds in the skin. It leads to blackening or discoloration around the nose area, causes blurred or double vision, pain in chest with difficulty in breathing and coughing blood. 

Mucormycosis is not contagious which means that it cannot be spread from contact between humans or animals. But it does spread from fungal spores that are present in the air or in the environment, which are almost impossible to avoid and most people who come in contact with the fungi do not develop an infection. However, people with severely weakened immune systems are at increased risk of mucormycosis.

Types of Mucormycosis

There are different types of Mucormycosis including Rhinocerebral (sinus and brain), Pulmonary (lung), Gastrointestinal, and Cutaneous (skin) Mucormycosis.

Rhino-Orbito-Cerebral Mucormycosis (ROCM)

In simple words, ROCM means the mucormycosis in which the fungus affects the nose, eyes and brain. This disease originates from the nose and rapidly spreads along the sinus passage to infect the orbit (bone cavity which surrounds the eye) and brain. Hence, the infection can be classified into three stages.

In the initial stage, the patient will experience either nasal blockage or congestion, nasal discharge (bloody or brown/ black) and localized pain inside the nose. The patient will then start to develop facial pain, numbness or even swelling of the face.

As the infection progresses and reaches the orbit, the patient begins to experience headache and orbital pain, which means pain in or behind the eye. Blurred or double vision with pain, vision loss in one or both eyes, partial or complete blindness can also be witnessed.

Toothache, loosening of teeth located in the upper jaw and dysfunction in jaw movement. Paresthesia, or abnormal sensation in the skin such as tingling, chilling, burning or numbness can be experienced. Patients also exhibit fever, skin lesions and a black eschar on the skin near the eyes or nose.

Unstable gait (mannerism of walking), altered consciousness and seizures indicate the spreading of the fungus to the brain.

Pulmonary Mucormycosis

Primarily affecting the lungs and respiratory system, pulmonary mucormycosis is common among immunocompromised patients whose immune systems have lowered ability to fight infections and diseases.

Patients with pulmonary mucormycosis exhibit symptoms including fever, cough, shortness of breath and chest pain. Some individuals go through hemoptysis as well, which means coughing up blood. Respiratory symptoms worsen as the infection spreads and patients may observe pleural effusion as well, which means fluid collection in the outer covering of lungs.

Who are prone and how did it spread?

The disease has a close link to diabetes, and conditions which compromise the immune system. People who have diseases like cancer, HIV, skin injury are also prone.

Experts have said that an overuse during the COVID-19 pandemic of certain drugs which suppress the immune system could be causing the surge. Mucormycosis can be triggered in humans by the use of steroids, a life-saving treatment which is for moderate-to-serious COVID cases. While steroids reduce inflammation in the lungs, it also reduces the overall immune response.

Experts say that unsanitary conditions could increase the risk of developing infections. There is a lot of contamination in the pipes used for oxygen, the cylinders that are being used.

Low oxygen, diabetes, high iron levels, immuno-suppression, coupled with several other factors including prolonged hospitalization with mechanical ventilators, creates an ideal milieu for contracting mucormycosis.

Black Fungus cases rise in India

Diagnosis of Black Fungus

If a patient exhibits symptoms of mucormycosis, it must be treated as a medical emergency and clinical diagnosis must be carried out immediately. Suspected patients should undergo appropriate radio-imaging study.

  • MRI PNS (para nasal sinuses) with brain contrast study for RCOM
  • Plain CT Thorax for pulmonary mucormycosis

Treatment of Black Fungus

Mucormycosis is often caused due to uncontrolled diabetes or misuse of steroids in immunocompromised patients. Hence, the first step is to control diabetes, maintain judicious use of steroids (time, dose and duration) and discontinue other immunomodulatory drugs. The need to control hyperglycemia (High sugar levels), especially after discharge following Covid-19 treatment is extremely crucial for both diabetics and non-diabetics.

Mucormycosis can be treated with a proper antifungal treatment, if the condition is detected early. In most cases, surgical debridement may be eventually required to remove necrotic material on the skin. A team approach is required which should include infectious disease specialist, microbiologist, histopathologist, intensivist, neurologist, ent specialist, ophthalmologist, dentist, surgeons and radiologists.

How to Protect yourself from Black Fungus?

While in hospital

  • Maintain good hygiene and cleanliness in your surroundings.
  • Maintain oral hygiene care with mouthwash, povidone-iodine gargles.
  • Use sterile water for humidification while administering oxygen, there should be no leakage from the humidifier.
  • Steroids usage should be limited not more than necessary with strict blood glucose control.
  • Avoid unnecessary use of broad-spectrum antibiotics or antifungals, which can result in growth of unwanted bacteria or organisms.

After recovering from COVID-19

  • Maintain your surroundings clean and free from dust and dampness.
  • Maintain your oral and nasal hygiene.
  • Try to stay indoors and do regular exercise or workout.
  • Avoid construction areas, fields and grounds.
  • Avoid gardening as soil and plants abound with fungi. Use rubber gloves, masks, and boots, if unavoidable.

Other Fungal Infections associated with COVID-19

White fungus is deadlier than black fungus, experts say. It spreads to several parts of your body and severely damages your lungs. Severe effects can be seen on the kidney, mouth, skin and brain. The White Fungus begins from the tongue or private parts, it makes the tongue white, and then it spreads to other parts like lungs, brain and food pipes.

Symptoms of white fungus – Cough,Fever,Diarrhoea,Dark spots on lungs,Reduced oxygen level, white patches in oral cavity, skin lesions.

Unlike black and white, Yellow Fungus starts internally, causes pus leakage, and leads to slow healing of wounds. In some serious cases, it could further lead to devastating symptoms like organ failure and acute necrosis (cell injury).First case of yellow fungus was reported in Uttar Pradesh’s Ghaziabad. Experts say yellow fungus can be scarier than black and white because of the manner it affects the body’s internal organs.

Symptoms of yellow fungus – Lethargy, poor appetite or no appetite,Weight loss or poor metabolism, sunken eyes.

How yellow fungus is different from white fungus and black fungus: Causes,  symptoms, risks and treatment

India was still fighting the COVID-19 pandemic and black fungus has made things more difficult for the medical infrastructure. But with the joint efforts of the government and citizens it is expected that we will surely come out of this adversity. The idea to have a healthy lifestyle in these times are simple – wear a mask when going out, maintain social distancing, eat healthy and stay fit.

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About our guest writer

Swyambhoo Pratap Singh
Swyambhoo Pratap Singh

Swyambhoo Pratap Singh is currently pursuing MBBS (Bachelor of Medicine and Bachelor of Surgery) (3rd term) from JSS Medical College and has done his schooling from CMS – Aliganj in Lucknow and DPS, Kanpur. He has lived in several places in India such as Lucknow, Kanpur, Nashik and Delhi. Currently living in Mysore, he likes Football, Cricket, reading books, Watching movies and TV series like The office, Anime, Food and Traveling.

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