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.
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.
Identification of high-risk patients in the COVID ward:
1) Examination of high-risk patients in the COVID ward.
2) Examination should be performed by an ophthalmologist:
- Baseline
- Weekly thereafter till the time of discharge.
- Follow-up after discharge to be explained.
Depending on the patient's condition, follow-up must be advised as follows:
1. Every two weeks for six weeks.
2. Monthly thereafter by teleconsultation for a period of three months from the time of discharge.
Ophthalmic Examination
History of nasal congestion or blockage, vision loss, double vision, pain, swelling, drooping of the lid, inability to close eyes, numbness or tingling around eyes or cheeks, difficulty in chewing, prominence of the eye, or any other ocular symptoms.
Examination:
1) Vision assessment (preferably aided) – subjective as reported by the patient, objectively with finger counting till a distance of 6 m.
2) Torchlight examination for facial asymmetry.
3) Full face examination, including the periorbital area for swelling, bluish or blackish discoloration/crust, induration, or tenderness.
4) Presence of proptosis by Worm's eye view.
5) Retropulsion test to assess the infiltration of the orbit (both eyes simultaneously will help to compare), Ptosis/ lagophthalmos, conjunctival chemosis or congestion ocular movements/ squint cornea, and anterior segment. Pupillary reactions V1 and V2 sensations Fundus examination if recent-onset visual complaints or RAPD - if possible educate the patient and caregiver about the signs and symptoms of rhino-orbital disease
6) Immediate consultation with ENT specialist.
7) Imaging with contrast to other relevant consultations on an urgent basis.
Danger signs of Black Fungus (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:
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.
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.
- 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Last reviewed at:
01 Aug 2023 - 4 min read
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Everything You Need to Know About Mucormycosis - 'The Black Fungus'
Article Overview: Black fungus, otherwise called Mucormycosis, is a possibly fatal fungal infection, rare but reported in some patients who recovered from COVID-19. Read the article to know more. Read Article
Introduction: Mucormycosis is a fungal infection caused by a group of molds called mucormycetes. It is also known as Zygomycosis. It is a serious but rare fungal infection and is also referred to as a black fungus. It usually affects the sinuses or the lungs after inhaling fungal spores from the air... Read Article
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