I have recovered from COVID. Will I get mucormycosis?

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I understand your concern. According to your statement, you want to know about black fungus or mucormycosis. It is an infection caused by a group of molds called mucormycetes living in the environment. It affects the sinuses, brain, or lungs of immunocompromised people. It also affects patients having cancer, AIDS (acquired immunodeficiency virus), uncontrolled diabetes mellitus, and patients taking steroids. It enters the body after inhaling fungal spores in the air. It can also enter the body through burns, cuts, or skin injuries.

The common symptoms of mucormycosis are headache, stuffy and bleeding nose, painful swelling of eyes, drooping of eyelids, blurring or loss of vision, facial pain, black crusts on the nose, and brain infection. A sample of fluid from the respiratory system or tissue biopsy from affected tissues are taken for fungal culture. According to the location of the infection, a CT scan (computed tomography) or MRI (magnetic resonance imaging) of lungs, sinus, or other body parts can be taken and it helps to diagnose the disease.

Antifungal medications like Liposomal Amphotericin B are taken. This disease has an overall mortality rate of 50%. Steroids trigger this condition in COVID-19 (coronavirus disease 2019) positive patients. Steroids can reduce immunity and increase blood sugar levels in diabetic and non-diabetic COVID-19 positive patients. Having a strict control of blood sugar levels during treatment and after recovery from COVID-19 infections helps to stop developing this disease. Taking the right dose and duration of steroids in COVID-19 positive patients also helps to prevent developing this disease.

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There is no definite time frame for getting this disease after recovering from COVID-19 infection. As mentioned earlier, it is a rare disease to occur. Immunocompromised patients are more prone to develop this type of disease. You have taken Dexamethasone 4 mg twice daily for ten days. You have taken it in the right dose and duration. As you are free from diabetes mellitus, AIDS (acquired immunodeficiency virus), cancer, and steroid treatment, so there are reduced chances for you to get infected by black fungus or mucormycosis.

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You have taken Dexamethasone for almost two weeks. While taking Dexamethasone, your blood sugar levels remained high. It is a Dexamethasone-induced raised blood sugar level. If your raised blood level does not come back to normal or if you are suffering from persistent uncontrolled blood sugar levels, then there are chances for you to develop this disease.

Steroids like Dexamethasone are not only used in COVID-19 infection but it is also used in treating various kinds of inflammation and diseases. In this case, persons having a history of taking steroids are more prone to develop black fungus. But this is not the cause. There are only a few patients with COVID-19 who have developed this disease.

For example, an asthmatic patient using a steroid inhaler is more prone to develop an oral yeast infection or oral candidiasis. Again women taking oral contraceptive pills are more prone to develop a vaginal yeast infection or vaginal candidiasis. So every steroid user does not develop mucormycosis. You have reduced chances to get infected with this rare fungus.

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According to your investigation reports (attachment removed to protect patient identity), your D-dimer is 0.92 mg/L and FEU (fibrinogen equivalent units) is above the normal level of 0.55%. Your CBC (complete blood count) shows that your RBC (red blood cells) and lymphocytes remain above normal. Elevated D-dimer level indicates the presence of blood clotting disorders like pulmonary embolism and deep vein thrombosis. Having a single value of elevated D-dimer value indicates that it remains high in you. It does not give a definite answer. Elevated D-dimer values take some time to return back to their normal position. In some cases, it takes around six months to return back to normal. Slightly elevated RBC does not indicate anything. One blood picture is not sufficient to predict anything. Results may vary from laboratories to laboratories, sample collection, use of reagents, and procedure pattern. You can repeat CBC and D-dimer a month later. Medical treatment is not required for elevated D-dimer values.

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Your RBC count is 5.58 x10^3 per microliter of blood and it remains slightly above normal as normal values lie between 4.50 to 5.50 x10^3 per microliter of blood. It does not confirm anything. The same test taken from another laboratory may vary and it may show red blood cells within normal limits. Similarly, your lymphocyte count is 46.60% which is slightly above normal as normal value remains within 20 to 40%. An increase in lymphocytes is referred to as lymphocytosis. A temporary increase in lymphocytes is common and normal to occur after an infection. So your immune system is working well. Again, your lymphocyte can be found normal or within normal range in another CBC report taken in another laboratory. Results may vary from laboratories to laboratories.

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After stopping anticoagulants like Apixaban, your D-dimer levels may get increased up to six months and gradually, it starts to decline and returns back to normal. Both Apixaban and Aspirin have side effects. Both of them can increase the chances of bleeding like gum bleeding, nosebleeds, coughing up or vomiting blood, red urine or stool, bleeding in internal organs like brain, eyes, and stomach. For this reason, concurrent use of Apixaban and Aspirin together should be taken under the supervision of a doctor because both of them can increase the risk of bleeding and so your doctor has stopped Aspirin while giving Apixaban. Most patients take Aspirin lifelong and do not take this medication without consulting a doctor. So I advise you consult your prescribed doctor before restarting Aspirin.

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Both of them are anticoagulants or blood thinners. They prevent clotting of blood in the bloodstream. But Apixaban is more effective than Aspirin and it causes some side effects. According to recent studies, Apixaban can reduce the risk of stroke by greater than 50% when compared with Aspirin. During COVID-19 infection, Aspirin or Apixaban is taken to prevent blood clots. It is taken for a month. After a month, it can be stopped. So it is necessary to consult a doctor before and after stopping this medication.

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Elevated ferritin levels occur due to obesity, inflammation, and alcohol consumption. Daily intake of vitamin C enhances iron absorption and keeps iron in its active form. High ferritin levels can cause some unpleasant symptoms like stomach pain, weakness, chest pain, palpitations, fatigue, and joint pain. Stop taking vitamin C. It will help to reduce your elevated ferritin levels. Elevated LDH (lactic acid dehydrogenase) occurs due to various reasons. Taking anticoagulants can cause it. So I suggest you stop taking anticoagulants like Apixaban. It helps to reduce your elevated LDH levels over time. As you do not have any symptoms of elevated ferritin, then there is nothing to be worried.

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According to your investigation report, your phosphorous level remains high. Elevated phosphorous levels in the blood can occur due to various health conditions. A high phosphate level indicates a sign of kidney damage in people with chronic kidney disease and those with end-stage renal failure. It remains raised in people having bone and muscle problems, infections, low calcium and vitamin D levels in the blood. Symptoms of high phosphorous in the body are joint pain, muscle pain, muscle weakness, nausea, vomiting, diarrhea, or constipation. If you are not suffering from these complications, then your phosphorous levels are not so high to produce other symptoms. Some phosphorous-containing foods can be avoided to reduce phosphorous levels in the blood. They are dairy products, beans, lentils, nuts, oatmeal, bran cereals, carbonated and other drinks, iced tea, processed meats, puddings, sauces, or cheese. Elevating calcium and vitamin D levels in the blood by taking calcium and vitamin D enriched foods or supplements daily helps to reduce phosphorus levels in the body. The levels of fibrinogen are not specific. It is an acute-phase reactant that can get increased at any time in the body due to new infection or inflammation or other reasons. As your fibrinogen level remains within range, then there is nothing to be worried.

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Diurnal variation has some impact on the serum phosphorous range of 0.6 to 1.0 mg/dL. The lowest concentration is observed between 8 AM to 11 AM. After 11 AM, it starts to increase, and at night, its concentration reaches high. I do not know when you gave the sample for the test. If you have given your sample in the evening or night, it remains high. Again, during cold weather, its level gets decreased.

On the other hand, it will become raised in hot weather. As your phosphorous level remains raised slightly lower than 1 mg/dL, I think that there is nothing to be worried about. Diurnal variation can also cause a rise in the value of serum phosphorous. You can repeat your phosphorous levels after few days. You can have any mistake in collecting samples, methods, instruments, or reagents. I suggest you repeat phosphorous levels after ten days. During these ten days, avoid taking phosphorous-containing foods. After doing your phosphorous levels after ten days, try to compare them with your previous abnormal report. A single raised value does not confirm anything.

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After 11 AM, your phosphorous level starts to increase, so some changes are observed in its value at 1 PM due to diurnal variation. A cup or 140 grams of roasted chicken contains 300 mg phosphorus. It is more than 40 percent of recommended daily intake of phosphorous. A large egg contains 95 mg of phosphorous. Dehydration can cause a rise in phosphorous levels. So it is difficult to predict the exact reason for raised phosphorous level. If you do not have any mistakes in your investigation procedure, then your phosphorous level will be normal in your repeat test taken. But if you have taken any high phosphorus-containing foods, then it remains high in your repeat test also. I suggest you repeat your phosphorous level test after ten days of having a result if it remains high.

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As your phosphorous level became normal, I think that your previous report can be wrong due to faulty sample technique, specimen, procedure, or any other reasons. Your CD3 (cluster of differentiation 3) is normal and CD4 (cluster of differentiation 4) remains high. CD8 (cluster of differentiation 8) is low but CD4 and CD8 ratio are 2.31. Having a value within 1 to 4 is considered normal. After a viral infection, CD8 remains decreased and it will become high over time. You can repeat CD8 count after a month.

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When you have a high CD4 count, it shows that your immune system is healthy. After recovering from a viral infection, CD8 remains decreased. This takes some time to return to normal. Other reasons to have decreased CD8 values are rheumatoid arthritis, SLE (systemic lupus erythematosus), multiple sclerosis, Sjogren's syndrome, systemic sclerosis, primary biliary cirrhosis, dermatomyositis, Crohn's disease, ulcerative colitis, primary sclerosing cholangitis, psoriasis, and many more causes. CD4 cells fight against infections, and CD8 cells can kill cancer cells and other invaders. Having a normal or increased level of CD4 and a ratio of CD4 and CD8 within 1 to 4 indicates intact immunity. You have a healthy immunity, and it works well.