Published on May 18, 2021 - 5 min read
Abstract
Black fungus, otherwise called Mucormycosis, is a possibly fatal fungal infection, rare but is being reported in some patients recovering from COVID. Read the article to know about its types, signs and symptoms, diagnosis, and treatment.
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. It usually affects the sinuses or the lungs after inhaling fungal spores from the air. It mainly affects people with comorbidities or those who have weakened immunity.
Mucormycetes are a group of fungi that causes fungal infection. It is usually present throughout the environment, especially in the soil, and in association with decaying organic matter such as leaves and animal dung. They are more commonly seen in soil than in the air and seen mostly during summer than in winter. These fungi are not harmful to most people.
There are many different types of fungi that belong to the scientific order Mucorales and cause mucormycosis. The most common types are:
Rhizopus species.
Mucor species.
The other types of fungi that cause Mucormycosis are:
Rhizomucor species.
Syncephalastrum species.
Cunninghamella bertholletiae.
Apophysomyces.
Lichtheimia.
Rhizomucor.
People who are more likely to get Mucormycosis are the
People with weak immune systems.
Ketoacidosis.
People with organ transplants.
Long-term usage of corticosteroids.
Neutropenia (low white blood cell -WBC) count.
It can occur on the skin after an injury or cut or any burn.
Hemochromatosis (an excessive amount of iron in the body).
Premature birth and low birth weight (in case of neonatal gastrointestinal mucormycosis).
Mucormycetes are present throughout the environment. When people come in contact with these mucormycetes, they inhale the fungal spores from the air. It mainly affects the lungs and sinuses. It can also cause a skin infection when fungus enters the skin through a cut or through any other type of skin injury.
Mucormycosis usually does not spread from person to person. It also does not spread between people and animals.
There are five clinical forms of mucormycosis in which; the two most common clinical forms are:
Rhinocerebral Mucormycosis.
Pulmonary Mucormycosis.
And the other clinical forms are:
Gastrointestinal Mucormycosis.
Cutaneous Mucormycosis.
Disseminated Mucormycosis.
Rhinocerebral Mucormycosis:
Rhinocerebral Mucormycosis starts as an infection in the sinus and then leads to swelling of the nerves in the brain. It causes blood clots in the brain. It is a fungal infection that involves the sinus and the brain. It is commonly seen in patients with diabetes, neutropenic patients, and renal transplants.
The symptoms seen are-
Unilateral facial swelling.
Headaches.
Nasal or sinus congestion.
Nasal discharge.
Fever.
Pulmonary Mucormycosis:
Pulmonary Mucormycosis is a lung infection. The common symptoms of pulmonary mucormycosis are-
Fever.
Chest pain.
Cough.
Gastrointestinal Mucormycosis:
Gastrointestinal Mucormycosis is less common than the other types of mucormycosis. It occurs after the ingestion of the organism. It usually occurs in malnourished patients and premature children. The parts that are affected are-
Stomach.
Ileum.
Colon.
The symptoms are-
Nausea.
Vomiting.
Non-specific abdominal pain.
Abdominal bleeding.
It is usually challenging to diagnose as it has similar clinical features as Necrotizing Enterocolitis.
Cutaneous (Skin) Mucormycosis:
Mucormycosis may appear as small blisters or ulcers. This infected region turns black in color. The symptoms seen are-
Swelling in that infected area.
Pain.
Warmth.
Redness around the wound.
Disseminated Mucormycosis:
Disseminated Mucormycosis occurs in people who are already suffering from other medical illnesses as the symptoms become difficult to diagnose if it is related to Mucormycosis or any other existing medical illnesses. There are chances of a coma state for patients with disseminated mucormycosis in the brain.
The healthcare professionals consider the previous medical conditions and the present clinical symptoms. A sample of fluid is collected from the lungs or sinuses and sent to the laboratory.
Doctors may also perform a tissue biopsy if needed.
Imaging tests like CT scans of lungs and sinuses can be recommended depending on the area of mucormycosis.
Mucormycosis is treated with antifungal drugs. It can be given either intravenously or orally. The drugs that are given intravenously are:
Amphotericin B.
Isavuconazole.
Posaconazole.
Isavuconazole and Posaconazole can also be given orally.
There are certain drugs that cannot treat Mucormycosis. They are:
Fluconazole.
Voriconazole.
Echinocandins.
But the drugs should be taken only after the Doctor’s consultation.
If necessary surgical debridement or resection can be recommended, particularly for rhinocerebral, cutaneous, and gastrointestinal mucormycosis.
The prognosis of Mucormycosis depends on the overall health condition of the patient and the body’s response to the treatment. Early diagnosis and treatment can give better outcomes, but if not treated or identified early, the overall mortality rate is 50%.
As mucormycetes are present throughout the environment, it is difficult to avoid inhaling the fungal spores from the air. There is also no vaccine available to prevent Mucormycosis. And people with weakened immunity and people with other medical conditions or illnesses can follow these steps to lower the chances of Mucormycosis.
Avoid areas with a lot of dust. If you cannot avoid then wear a mask when going to these areas.
Avoid activities that involve contact with dust or soil. If this is not possible, then:
Try wearing gloves while handling.
Wear long-sleeved clothes.
Clean the injuries with soap and water. Keep it clean.
There are reports saying that Mucormycosis is seen in few COVID patients. COVID-19 is caused by SARS-CoV-2 and commonly occurs in patients with weak immunity and also elderly patients. Elderly patients are more likely to have medical conditions like diabetes, Hypertension, and other renal issues, which makes them more prone to opportunistic fungal infections like Mucormycosis. Health experts consider steroids a life-saving treatment for severe and critically ill COVID-19, whereas steroids are a trigger factor for Mucormycosis, and the overall mortality rate of Mucormycosis is 50%. So health experts say that these could be the reasons for Mucormycosis to be seen in COVID patients.
Mucormycosis is a rare but serious fungal infection. Early diagnosis, predisposing risk factors, and appropriate treatment, which includes prompt prescription and administration of antifungal medications, can have better prognoses and outcomes. And in this pandemic situation, extra care and precautions have to be followed as Mucormycosis is said to be noticed in recovered and recovering COVID-19 patients. It would be more challenging and risky to treat Mucormycosis in this pandemic situation. So it is necessary to stay safe and healthy.
Mucormycosis is a fungal infection that is treated with prescribed antifungal medications usually:
- Amphotericin B.
- Posaconazole.
- Isavuconazole.
Mucormycosis sometimes needs to be treated with surgery to remove the infected tissue.
Mucormycosis affects the sinus, brain, gastrointestinal system, lungs, skin, and sometimes it spreads to the kidneys.
There are different types of mucormycosis, and they are
- Rhinocerebral mucormycosis- It affects the sinus and the brain.
- Pulmonary mucormycosis- It affects the lungs.
- Gastrointestinal mucormycosis- It affects the gastrointestinal system.
- Cutaneous mucormycosis- It affects the skin.
- Disseminated mucormycosis- It occurs when the infection spreads through the bloodstream to the other parts of the body. It commonly affects the brain, spleen, heart, and skin.
The healthcare professionals record your symptoms, physical examinations, medical history, and laboratory tests for the diagnosis of mucormycosis. If they suspect mucormycosis in the lungs, they may collect the sample of fluid and send it to the laboratory for diagnosis. They may also perform a tissue biopsy if needed. Sometimes CT scan for lungs, sinuses, and other parts of the body may be recommended depending on the site of the fungal infection.
Mucormycosis has a poor prognosis with a mortality rate of 17-51%. If the diagnosis is delayed, the mortality rate can be higher. Surgical treatment associated with antifungal medicine can improve the prognosis.
Cutaneous (skin) mucormycosis may look like small blisters or ulcers, and the infected area turns black.
- The symptoms of Rhinocerebral mucormycosis are:
One-sided facial swelling
Headache
Black-colored lesions on the nasal bridge or inside the mouth.
Fever.
- The symptoms of pulmonary mucormycosis are:
Shortness of breath
Cough
Chest pain
Fever.
- The symptoms of gastrointestinal mucormycosis are:
Abdominal pain
Nausea
Vomiting
Abdominal bleeding.
Once established, the fungi multiply rapidly in the blood vessel walls, which cuts the blood flow to the tissues resulting in tissue destruction. If this spread of fungal infection is not stopped, it can even lead to death.
The infection is common among people who have weakened immune systems. There are various risk factors like
- Uncontrolled diabetes
- Skin cuts or injuries or burns
- Cancer
- Organ Transplant
- Low Blood Cell Count (Neutropenia).
Black fungus is a rare infection, and it can turn dangerous if left untreated. Once you are diagnosed with mucormycosis, start the treatment immediately. Delaying the treatment can increase the complications.
No, black fungus is not contagious, and it mainly affects the persons who are on prolonged steroids and immunocompromised individuals. The possibility of spreading the infection from person to person or through oxygenation, humidifier, or water are considered myths of black fungus.
Mucormycosis is a rare but serious infection caused by a group of fungi called Mucormycetes that lives throughout the environment. It is also called Zygomycosis. It is seen in people who have weak immune systems or any other health illnesses. It affects the sinuses or lungs after inhaling the fungal spores from the air. It also looks like small blisters or ulcers on the skin after a cut or injury, or burn.
Black fungus is a fungal infection that is caused by Mucormycetes. It is present throughout the environment, particularly in the soil rather than in the air, associated with dead and decayed organic matter such as leaves, compost, and animal dung. It enters the body when the fungal spores from the air are inhaled. It then causes an infection in the sinuses and lungs and later spreads to different parts of the body.
Certain evidence shows that COVID-19 infection can lead to intestinal infection and be present in feces. There are no reports saying about the fecal-oral transmission of coronavirus.
Last reviewed at:
18 May 2021 - 5 min read
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