Black Fungus Maiming COVID Patients

What Is Black Fungus?

It is also called zygomycosis or mucormycosis. It is a serious fungal infection caused by molds Mucormycetes. These are mucor molds that live in soil, plants, manure, decaying fruits, and vegetables, etc.

How Do Black Fungus Maim COVID Patients?

Increased number of fungal infections post-COVID infection is being reported in the second wave of COVID-19. These opportunistic fungal infections were rare or none during the first wave of COVID-19 infection, but reports from different parts of India are showing an increase in the number of cases of deadly fungal infections even after recovery from COVID-19, and few cases of fungal infections are reported even during treatment of COVID-19.

Because of a lack of knowledge about these opportunistic fungal infections, there is a delay in the diagnosis of these infections. By the time the patient reaches the higher centers for the treatment, the infection will be in its advanced stage. Irrespective of the age of the patient, its spread is rapid and dangerous as these are life-threatening conditions. COVID-19 patients, even after recovery from the Coronavirus, are prone to develop severe opportunistic infections. There are many reports of the development of severe opportunistic fungal infections such as:

• Rhino-orbital mucormycosis.

• Oropharyngeal candidiasis.

• Pneumonia.

• Pulmonary aspergillosis.

• Bloodstream candida infections.

When discussing opportunistic fungal infection, Candida and Aspergillus are more common infections, but mucormycosis is fatal and life-threatening because its spread involves sinuses and the brain. A number of cases of deadly mucormycosis have been reported in recovering COVID-19 infection, and mucormycosis is also known as black fungal infection. In this pandemic situation, this rare fungal infection is triggered by Coronavirus infection, and treatment protocol that involves the use of steroids causes reduced immunity of patients that ultimately leads to increased susceptibility for infections, apart from various other factors such as:

• Inadequate and unhealthy food habits.

• Stress.

• Uncontrolled diabetes.

• Infection.

• Inflammation related to hormonal surge.

These factors in the body affect the immunity of a person that can trigger and increase susceptibility for such opportunistic infections.

What Is the Role of Steroids?

In case of treatment of Coronavirus infection, steroids are mainly given to reduce inflammation in the lungs that have occurred in COVID-19 infection. It will also restrict the damage that occurred in the body of an individual due to coronavirus infection. But, there are some adverse effects of steroids such as,

• It raises the blood sugar level in COVID-19 patients (diabetic and nondiabetic).

• It reduces the immunity of the patient, which will be a favorable situation for other opportunistic infections to attack the body.

So in the case of COVID-19 and mucormycosis, these exacerbating factors are seen:

• Diabetes - Causes decreased immunity.

• COVID-19 Infection - Acts as a triggering factor.

• Steroids - Acts as a fuel for other opportunistic infections.

Who Are at Risk of These Opportunistic Fungal Infections?

Patients with risk for these opportunistic fungal infections are,

• Patients getting treated for COVID-19 are on steroids that cause the compromised immune system of a patient who is already sick.

• Patients with comorbidities such as diabetes, kidney problems, lung problems, cardiac problems are at higher risk of opportunistic fungal infection.

• Patients with diabetic ketoacidosis have elevated levels of free iron in their serum. It is seen that the growth of these pathogens is stimulated in a host having a high free iron concentration in serum when pH is acidic, as these pathogens utilize this free iron in serum for its growth or multiplication. Alkaline pH does not favor the growth of these pathogens.

• Long hospital stay, ICU stay, use of ventilators, when the patient is kept on oxygen which has a humidifier containing water then there are more chances of the patient getting infected by opportunistic fungal infections.

• Patient getting treatment with glucocorticoids.

• The patient having hematologic malignancies.

• Patient having hematopoietic cell transplantation.

• Patient having organ transplantation.

• The patient is on treatment with Deferoxamine.

• High free serum iron overload.

• Patient with AIDS.

• Patient having trauma or burns or non-healing wound.

• Patients with malnutrition or improper food habits.

What Are the Symptoms of Mucormycosis?

Symptoms of mucormycosis or commonly known as black fungus, are:

• Fever.

• Headache.

• Dry cough.

• Sometimes cough with a bloody dark fluid expectorant.

• Swelling in a region of eyes or nose.

• Obstruction of the nose.

• The black crust in the nose.

• Stuffy nose.

• Bleeding nose.

• Pain in the eye or around the eyes.

• Drooping of eyelids.

• Blurred vision, if left untreated, progression leads to loss of vision.

• Invasive brain infection.

• Black patches around the nose.

• Shortness of breath.

• Diffuse abdominal pain.

• Vomiting sometimes with blood.

• Abdominal distension.

• Ulcer with a dark center and sharp edges.

All these symptoms should be immediately suspected and addressed, and prompt biopsy should be carried out, and the start of antifungal treatment is needed as earliest as possible (under the guidance of a physician).

Fungal infections such as black fungus or mucormycosis treated early with antifungal drugs (under physician guidance) can prevent the patient from a complicated surgery. The surgery may involve eyes, nose, and jaw bone resection or removal to prevent further spread of infection to the brain. The mortality rate is high in this black fungus infection if diagnosed late or left untreated.

What Needs to Be Done to Prevent This Condition?

Prevention is the best way for such kinds of conditions. Prevention is carried out by avoiding or controlling the precipitating or triggering factors for it as there is no vaccine available for mucormycosis. So, follow the preventive measures such as:

• The use of a mask is mandatory, even when you are visiting any polluted or dusty places.

• When going in soil or manure or mosses then one should wear shoes, clothes having long sleeves and full trousers.

• Use of gloves is preferred while visiting such places. Maintain proper personal hygiene.

• Focus on increasing patient's immunity.

• One should keep a close watch on blood sugar levels even after recovery from COVID-19 and discharge from the hospital irrespective of the patient's past history of diabetes.

• Maintain proper oral hygiene.

• Patients are advised to do twice brushing daily (morning and at night), gargling with betadine solution, or with chlorhexidine mouthwash.

• Keep an eye on the non-healing ulcer or an ulcer, any sinus opening in the oral cavity or on the palate, any white or black fungus type growth in the oral cavity.

• Any abnormalities in the oral cavity, nose, eyes, or area around eyes and nose should be checked and evaluated at the earliest. Early diagnosis plays a major role in preventing life-threatening complications.

Conclusion:

Post COVID care and management of sequelae have become very important in the second wave of COVID-19 disease. Prevention of such opportunistic infections with utmost care is very important and mandatory to avoid further complications. Later awareness, prompt screening, diagnosis, and adequate, aggressive management of this fungal infection is a must as it is fatal if left untreated.