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Black Fungus (Mucormycosis) And COVID-19

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Black Fungus (Mucormycosis) And COVID-19

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Mucormycosis is a deadly fungal infection and is at a higher prevalence in COVID patients or those recovering from COVID. Read the article to know more.

Medically reviewed by

Dr. Chithranjali Ravichandran

Published At May 15, 2021
Reviewed AtAugust 2, 2023

What Is Mucormycosis?

Mucormycosis is a deep fungal infection that occurs primarily in two forms:

1) Acute.

2) Aggressive.

The majority of oral fungal infections arise mainly because of impaired host immune response and local pathological colonization. The infection, also known as "Black Fungus," is now a predominant risk factor for COVID-19 patients currently who either have uncontrolled diabetes mellitus or the cases where Intensive care unit/ICU stay is prolonged. This rare yet deadly fungal infection in COVID-19 cases especially affects the brain and lungs.

The cases of black fungus in COVID patients have been on the rise as the Government of India has issued an evidence-based advisory to the general public. The advisory mainly emphasizes that people who are on certain medications have a reduced ability to fight environmental pathogens.

How Does It Occur (Pathogenesis)?

The fungal spores primarily enter through the inhaled air, directly impacting the respiratory tract and lungs, open and cut wounds (when the spores enter through the skin), sinuses, or through lung infections. People suffering from immune disorders and people on immunosuppressant drugs are at a high risk of superficial to deep fungal infections in the oral tissues. Mucormycosis is caused by saprophytic fungi like Rhizopus, Mucor, Rhizomucor, Cunninghamella, Apophysomyces, Lichtheimia, or Saksenaea.

The fungal spores germinate within the host's immune system to generate hyphae by eventually invading the systemic tissues and creating clinical symptoms. Impaired immune functions in certain conditions like diabetic ketoacidosis can lead to accelerated growth of mucormycosis. Impaired phagocytic (cells for immune defense to fight bacteria and foreign organisms) functions, on the other hand, create more hyphae in the blood vessels leading to complications like ischemia, thrombosis, infarction, and tissue necrosis. There are mainly six well-recognized forms of mucormycosis:

  1. Pulmonary.
  2. Gastrointestinal.
  3. Central nervous system.
  4. Rhinocerebral.
  5. Cutaneous.
  6. Disseminated oral mucormycosis.

Disseminated oral mucormycosis is the manifestation currently in COVID-19 cases (blank fungus). It most often occurs in the nasal and paranasal sinuses of the face. Serious involvement of the paranasal sinuses of the face can thus result in palatal necrosis and ulceration, which is the most common oral diagnosis by the dental surgeon or oral and maxillofacial surgeons.

What Are the Symptoms and Risk Factors for Mucormycosis?

The major risk factors for mucormycosis in the current scenario of the peak wave of the pandemic is the following in a statement issued by the ICMR (Indian council of medical research):

  1. Prolonged ICU stay or prolonged duration of patients on ventilator support.
  2. Uncontrolled diabetes mellitus.
  3. Patients on immunosuppressants and steroid therapies.
  4. Malignancies and therapeutic agents or drugs used for it.
  5. Fungal infections of the oral cavity and Voriconazole therapy (an antifungal drug used as a therapeutic agent).

In COVID-19 patients with uncontrolled diabetes mellitus and immunosuppressed individuals, these symptoms are of particular importance to suspect a mucormycosis Infection:

  1. Sinusitis or inflammation of the nasal or paranasal sinuses.
  2. Nasal blockage and congestion.
  3. Unilateral or one-sided facial pain and numbness.
  4. Blackish discoloration of the bridge of the nose or on the palate of the mouth.
  5. Loosened teeth and painful tooth conditions.
  6. Chest pain that may be accompanied by worsening respiratory symptoms like breathlessness (increase in the number of breaths per minute, hypoxia or low oxygen saturation - PO2), wheezing, grunting, retractions, and color changes.
  7. Thrombosis (blood clots in different areas of the body that prevent normal blood flow).

What Are the Preventive Measures During and After COVID-19 Recovery?

According to the WHO, the SARS-COV-2 pathogen mainly spreads via tiny droplets that arise from an infected person's mouth when they cough, sneeze, talk, or laugh. Hence the oral cavity, which forms a major part of the immune defense against the novel Coronavirus, should be strictly maintained in hygiene. Doctors suggest the following measures as per the latest research, which indicates that the oral cavity can be a reservoir of microorganisms that maintain their viability for a significant period of time, ranging from 24 hours to 7 days. Microbial survival promotes the easy spread of fungal or viral pathogens into the oral cavity.

Brushing daily for a minimum of two minutes every day should not be ignored by COVID patients and those who have recovered from COVID.

  1. Toothbrushes should not be shared commonly nor be kept in a common holder as the virus has a tendency to replicate via infected surfaces.
  2. COVID-19 patients in a clinical setting are advised by physicians and dentists to rinse their mouth with Betadine gargle or regular antiseptic mouthwashes. In the absence of mouthwash, the patient can also rinse with warm saline water or warm salt water to ward off infection spread through the oral cavity.
  3. Disinfecting the toothbrush in an antiseptic solution while the patient is suffering from COVID also helps maintain infection control in a clinical setting or in-home quarantine.
  4. Post recovery from COVID, toothbrushes need to be disposed of and replaced by a new brush as the virus may have thrived on the bristles of the brush that can cause respiratory infections afresh.

What Are the Treatment Strategies for Mucormycosis?

Early detection and multidisciplinary treatment is the gold standard for physicians and maxillofacial surgeons to detect Mucormycosis. Controlling diabetes and modulating immunosuppressant drugs. Proper oral hygiene, diagnosis by the dentist, and relevant antifungal therapy to treat this fungal infection are useful in the further aggravation of the deadly fungus. As per government advisory, medical treatment once a COVID patient is infected with mucormycosis is mainly by insertion peripherally of a central catheter to maintain systemic hydration in the body. Infusion of normal saline and treatment with the drug Amphotericin B before infusion of the saline intravenously is also a mainline treatment.

The patient should be monitored thoroughly by the dentist and the physician in a COVID clinical setting while oral and physical examination. Radio imaging has also been useful in knowing the stage of disease progression of the fungus as it primarily impacts the brain and lungs though its manifestation is seen more in the oral cavity and the sinuses of the face. Hence self-medication by the COVID patients (or asymptomatic COVID patients who suspect a fungal infection for mucormycosis) is strictly not advisable. Without consulting a physician or maxillofacial or dental surgeon, the infection in the current scenario is indeed life-threatening.

Oral hygiene and standard is a major and crucial factor to recovery from this deadly fungal infection.

Frequently Asked Questions

1.

Are Mucormycosis and COVID Co-related?

It has been found that patients with underlying hyperglycemia (uncontrolled diabetes) who were recovering from COVID or have been through severe infections due to covid are at greater risk of having black fungus or mucormycosis.

2.

Can COVID cause fungal infections?

 
Patients with COVID are at increased risk of developing fungal infections. Fungal infections like mucormycosis, candidiasis and aspergillosis are more common in patients recovering from COVID (due to compromised immunity) or with severe COVID infections. COVID Patients with uncontrolled diabetes are at greater risk of getting fungal infections.

3.

What Is Black Fungal Infection Seen With COVID?

 
Black fungal infection or Mucormycosis is a severe fungal infection caused by the molds like Rhizopus arrhizus. Patients with COVID who have an underlying systemic disease like uncontrolled diabetes are at greater risk of getting the black fungus infection or mucormycosis.

4.

How Long Does It Take for a Black Fungal Infection to Occur After COVID?

After the COVID infection, the immunity of the patient is compromised severely making the body more prone to the fungal infection. Around 10 to 20 days after the COVID infection after the body's immune system weakens, black fungus or mucormycosis can occur.

5.

How Do I Know If I Have black Fungus Infection?

Some of the signs and symptoms presented by black fungal infection or mucormycosis that help to know the presence of infection are:
 - Black patches on the mucosa around the nose.
 - The black crust in the nose.
 - Dry cough.
 - Black patches on the palate.
 - The blurring of vision.
 - Ulcers with dark centers.
 - Pain in or around the eyes.

6.

Why Does COVID Cause Black Fungus Infection?

 
COVID infection weakens the immune system completely due to the long-term use of steroids and other medications. It makes the body more prone to mucormycosis. Patients with underlying systemic diseases like diabetes or hypertension are at higher risk of getting an opportunistic black fungal infection.

7.

What Are the Initial Symptoms of Black Fungus?

Primary symptoms associated with the black fungus infection or mucormycosis are:
 - Pain in or around the eyes or face.
 - Fever.
 - Black discoloration around the nose.
 - Swelling of the face on the affected side.
 - Nasal congestion.
 - Frequent headaches.
 - Redness around the eyes.
 - The black crust in the nose.
 - Dry or scratchy throat.

8.

What Parts of the Body Are Affected by Black Fungus?

Black Fungus is a gradually progressing disease and can involve different body parts like the nose, oral cavity, eyes, abdomen, sinus cavities, skin, or mucous membrane. In severe cases, it can also involve the lungs (pulmonary mucormycosis) and the brain.

9.

Can Mucormycosis Be Treated?

Early diagnosis of black fungal infection is very crucial for a complete cure of the infection. Various antifungal medications like Amphotericin B, Posaconazole, or isavuconazole can be used for the management of the black fungal or mucormycosis infection. These medications can be given either intravenously or in oral tablet form.

10.

Can Healthy People Get Mucormycosis?

It is very unusual for healthy patients to get a black fungal infection or mucormycosis. However, patients with compromised immune systems due to underlying diseases like diabetes or cancer and long-term use of immunosuppressive drugs can result in opportunistic infections like mucormycosis to trigger.

11.

What Are the Triggering Factors of Mucormycosis?

Mucormycosis or black fungal infections can be triggered due to the following factors:
 - Uncontrolled diabetes.
 - Long-term use of steroids.
 - Patients on immunosuppressive drugs.
 - Long-period hospitalization, ICU stay, or ventilator support.
 - Patients with underlying Cancer or recent organ transplant.
 - Cuts or open wounds on the skin.
 - HIV or AIDS (acquired immunodeficiency syndrome) patients.

12.

How Quickly Does Black Fungal Infection Progress?

Mucormycosis or black fungal infection is a slowly progressive fungal infection. Around 7 to 15 days is the minimum incubation period for mucormycosis infection. Due to the slow spread of infection, it may cause a delay in diagnosis.

13.

How Do You Test for Black Fungal Infection?

The black fungus infection can be diagnosed by a very simple and reliable technique which involves the collection of the fluid sample from the nose and sending it to the laboratory for further investigation. Other diagnostic tests such as biopsy can also be advised by the doctor for confirmatory diagnosis.
Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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mucormycosisblack funguscovid-19fungal infection
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