Early Detection and Prevention of Black Fungus (Mucormycosis)

Written by

and medically reviewed by Dr. Chithranjali Ravichandran

Published on Jun 07, 2021 and last reviewed on Aug 01, 2023 - 4 min read

Abstract

Mucormycosis is like an epidemic; therefore, doctors need to identify the patients at high risk for early detection and prevention of the disease.

Contents

Who Are at High Risk?

What Are the Guidelines Given for Ophthalmologists by AIIMS?

What Is the Advice Given to the Patients and Caregivers for Detection and Prevention?

How to Prevent the Spread of Mucormycosis?

Early Detection and Prevention of Black Fungus (Mucormycosis)

Introduction:

The second wave of COVID infection has led to an increasing number or spike in black fungus or mucormycosis cases that can prove fatal, especially in immunosuppressed patients and diabetics. AIIMS (All India Institute of Medical Sciences) has released a new set of guidelines for the early detection and prevention of black fungus.

Who Are at High Risk?

Identification of high-risk patients in the COVID ward:

Uncontrolled diabetes, diabetic ketoacidosis, and diabetics on steroids/Tocilizumab.
Patients on immunosuppressants or anticancer treatment or those with chronic debilitating illnesses.
Patients on high-dose steroids and/or long duration of steroids/Tocilizumab.
Severe COVID disease.
On oxygen support.

What Are the Guidelines Given for Ophthalmologists by AIIMS?

1) Examination of high-risk patients in the COVID ward.

2) Examination should be performed by an ophthalmologist:

- Baseline

What Is the Advice Given to the Patients and Caregivers for Detection and Prevention?

Danger signs of Black Fungus (mucormycosis):

Abnormal black discharge or crust or blood from the nose.
Nasal blockage.
Headache or eye pain.
Swelling around the eyes, double vision, redness of the eye, loss of vision, difficulty in the closing eye, inability to open the eye, prominence of the eye.
Facial numbness or tingling sensation.
Difficulty in chewing or opening mouth.
Regular self-examination - Full face examination in daylight for facial swelling (especially nose, cheek, around the eye) or black discoloration, hardening, and pain on touch.
Loosening of teeth.
Black areas and swelling inside the mouth, palate, teeth, or nose (oral and nasal examination using torchlight, as far as possible you can see).

How to Prevent the Spread of Mucormycosis?

The national COVID-19 task force in India has issued an evidence-based advisory on the main measures to be taken for controlling the spread and precautionary measures on an everyday basis for both the patients who have recovered from the COVID infection and the patients in the ICU wards and COVID wards. The following measures need to be implemented by any individual affected by the COVID virus hence:

Firstly, self-medication by the patient is strictly not indicated. Mucormycosis is a dangerous fungal infection with deep-rooted systemic manifestations that mainly target the brain, sinuses, and lungs. Any of the symptoms pertaining to mucormycosis should be strictly reported by the patient or those in contact with the patient to curb its spread as an epidemic.
Immediate consultation with the ENT doctor, ophthalmologist, or treating doctor in case of any abnormal findings. MRI/CT with contrast - paranasal sinuses and orbit, if needed-on doctor's advice.
It is important for the physician to monitor the patient's blood sugar levels and to reduce steroid usage, and, if possible, discontinue the use of immunomodulating drugs.
The patient's treatment for mucormycosis specifically should not be discontinued at least for 4-6 weeks or, as advised by the physician, to rule out the possibility of recurrent infection in the individual.
As steroid usage in the treatment of COVID infection and in mucormycosis is implemented by many doctors, the patient should maintain extra personal hygiene and environmental hygiene. As the effects even after treatment by steroids continue to last 3-4 weeks and the patient's immune response may not be normal, it will still be in a state of immune suppression, hence the need for extra precaution after treatment.
As the oral immune defense is breached primarily in mucormycosis, oral hygiene maintenance is of pivotal importance. Regular mouth washing with betadine gargle or an antiseptic mouthwash every day, along with disinfection of the toothbrush in an antiseptic solution, will definitely reduce the risk of transmission of the fungal infection via the oral route. Also, toothbrushes need to be disposed of after recovery from COVID infection, and in the absence of a mouthwash, daily rinsing with warm saline or saltwater will also aid in maintaining oral hygiene. Toothbrushing twice a day and mouth washing are essential to keep the immune response of the oral cavity from the reservoir of fungal or viral pathogens that it is prone to.
Physicians in COVID wards are instructed to check the patient's nose (the nostrils) and skin for signs of any infection. The water used in oxygenation should be cross-checked for contamination, and the patient's oxygen mask and cannula need to be sterile to prevent the fungal invasion by the pathogens.
Proper use of masks (three-ply masks), gloves, and fully covering one's arms and legs while staying in damp or dusty places for the COVID patient will prevent the spread of infection. If possible, damp and dusty places need to be avoided by the COVID patient.

Hence timely detection and diagnosis in high-risk cases and patients affected by COVID is the need of the hour to prevent the spread and the secondary infections that follow because of mucormycosis.

Frequently Asked Questions

1. How Can One Detect Mucormycosis Early?

A tissue biopsy can be used to make an early diagnosis, in which a small sample of damaged tissue is examined under a microscope or in a fungal culture in a laboratory for evidence of mucormycosis.

2. How To Prevent Mucormycosis Infection?

- Better glycemic management in people with diabetes, proper administration of systemic corticosteroids, and reduced unnecessary antibiotic, antifungal, and immunomodulator use.
- When visiting dusty or construction sites, wear a face mask to avoid inhaling fungal spores that could cause mucormycosis and excess mucus.

3. What Are the First Symptoms of Black Fungus?

Mucormycosis on the skin might appear as blisters or ulcers, and the diseased region can darken. Individuals may also experience discomfort, warmth, redness, or swelling near a cut. Mucormycosis of the GI tract can cause abdominal pain.

4. How To Detect Black Fungus?

Sinusitis or nasal blockage and congestion are black fungus symptoms that signal you have a fungal infection caused by black fungus and mucormycosis. Keep an eye out for nasal discharge with a sticky appearance or a hint of blood in it.

5. How Is Mucormycosis Diagnosed?

A tissue biopsy is a procedure where a small sample of the affected tissue is examined in a lab for signs of mucormycosis under a microscope or in a fungal culture.

6. How to Prevent Getting Infected With Black Fungus?

When individuals are out in nature or working with dirt and manure, make sure to protect themselves by wearing appropriate footwear, long pants, t-shirts with full sleeves, and gardening gloves. This will keep oneself safe and prevent the symptoms of black fungus. In addition, one needs to practice good hygiene by regularly changing their clothes, giving scrub baths, and continuously washing their hands.

7. What Triggers Mucormycosis?

Mucormycosis primarily affects persons with health problems or who use medications that reduce the body's capacity to resist infections and illness. It typically affects the sinuses or the lungs after breathing fungal spores from the air. It might also manifest following a skin wound, burn, or cut.

8. What Treatments Can Cure Black Fungus Naturally at Home?

One can try this home remedy by mixing one teaspoon of Gudici powder, one teaspoon of Tinospora cordifolia powder, one teaspoon of Neem powder, one teaspoon of turmeric powder, and a half glass of water. The mixture should be taken three times a day.

9. How Quickly Does Mucormycosis Progress?

The incubation period for mucormycosis is typically between one and two weeks. However, there are sometimes delays in diagnosis, and the progression of the disease naturally occurs fast over just a few days.

10. Can Mucormycosis Be Cured?

Mucormycosis, also known as zygomycosis, was formerly believed to be a rare infection, but it is now the second most common invasive mould infection. Despite the development of more recent antifungal medications, the death rate associated with mucormycosis continues to be alarmingly high. The early diagnosis of mucormycosis is essential to the successful care of the condition, as is the reversal of any underlying predisposing risk factors, surgical debridement, and the quick delivery of active antifungal medications. Mucormycosis, on the other hand, does not always respond favorably to treatment.

11. How Long Can One Have Mucormycosis?

According to the literature reviews, the average time that symptoms lasted was reported to be 11 days and can be between 2 to 30 days.

12. Can CT Scan Detect Mucormycosis?

Yes, it is possible to detect mucormycosis through a CT (computed tomography) scan. Sinonasal mycosis can be found with CT, which is 100 % accurate and 78 % specific. Imaging features may look like cancer, but invasive fungal infections should be considered in the proper clinical situations.

13. Who Is at Risk for Mucormycosis?

In a patient with a recent history of COVID-19 infection, the most critical risk factors for developing mucormycosis are uncontrolled diabetic mellitus and high-dose steroid treatment and individuals with low immunity.

14. Is There a Blood Test for Mucormycosis?

Mucormycosis can not be found with any biochemical markers. Fluid culture's bronchoalveolar lavage (BAL) has a low yield and is only 20 % to 50 % sensitive. This infection can not be found with beta-D-glucan or galactomannan antigen tests.