Why should you know about Mucormycosis?

The second wave of Covid-19 infections has done more damage than the first, bringing unprecedented deaths and slowdown of the economy, in almost every country of the world. In addition to the shortage of vaccines, drugs, hospital beds and oxygen cylinders, many countries are facing a new crisis. Covid-19 patients who have recovered or recovering are developing Mucormycosis, which has serious consequences including fatality. So it’s important, everyone is aware of this condition.

What is Mucormycosis?

Mucormycosis (MM), also called Black Fungus, is an infection caused by a fungus called Mucor. Mucor is found abundantly in nature, in soil, manure, water, air, on plants and trees, and even in the nose and mucous of healthy people. Most people are immune from its effect, but for a small minority of people who are severely diabetic, have poor immunity (immunocompromised), such as cancer and HIV patients, transplant patients with co-morbidities, the fungus can create serious problems. So also, people who have had a prolonged ICU stay or voriconazole therapy are at risk. The fungus causes a wide range of symptoms, leading to disabilities, and deaths in some cases.

Black fungus and Covid – what’s the connection?

Covid-19 virus causes inflammation in the lungs and reduced oxygen transfer. The inflammation is a consequence of the body’s immune system trying to fight the virus hard. But since  excessive inflammation can cause great harm, doctors prefer to suppress the hyper-immune reaction and thus the inflammation. This is done by giving steroids.

But the unfortunate (and expected) outcome of this approach is impaired immunity in Covid patients. Some of these patients who are severely diabetic, or have low immunity, have developed Mucormycosis (MM) during the first wave, now being increasingly reported also in the second wave. Patients who are between 8 to 10 days from start of Covid infection are vulnerable to black fungus. In some countries, Covid patients who were cured have also developed the condition many days later, which is baffling doctors and worrying patients.

How serious is the problem?

Mucormycosis are of two types, rather, there are two manifestations of the condition.

• Rhino-orbito-cerebral (ROC-MM): As the name implies, the nose, eyes and skull area are severely affected here.
• Pulmonary (P-MM): As the name implies, the lungs are severely affected here.

Symptoms to watch out for

• ROC-MM: Congestion or blockage in the nose, dark red or blackish discharge from the nose; facial pain, numbness, swelling or pain in the eyes, headache, toothache, loose tooth, pain in the jaw; blurred vision, double vision, pain in one side of the face; tingling sensation in the face; fever, black lesions on the skin especially on the nose (hence the name black fungus).
• P-MM: Cough, blood in the sputum after coughing, vomiting blood, chest pain, pleural effusion, respiratory symptoms that get worse with time, haemoptysis and fever

Treatment

• Medication: Fungicides are given as oral medicines or injections at the rate of one injection per day, to destroy the fungus or limit its spread. In rare cases, the drug may have to be given intravenously, which involves implies hospitalization. If the patient is still undergoing treatment for Covid, medication for MM and Covid will be given parallelly. Else, if the patient has been cured of Covid, discharged and then developed MM, or developed MM in the last days of treatment, the medication is given as an out-patient procedure, or at home.
• Surgical intervention: Using a needle similar to the ones used in biopsies, or a shorter endoscope, the diseased tissue is removed from the nasal cavity, sinuses or any other part of the skull which can be accessed easily. Physically removing the tissue over 1 or 2 sessions can limit the spread while fungicidal medicines given in parallel destroy the virus.

Prevention

The fungicidal injections mentioned above are costly and have to be given at the rate of 1 per day over 8 weeks since the time MM is detected. This can blow a hole in the pocket of most patients. That is why, a more preventive approach is pursued by the medical fraternity worldwide to reduce the risk of developing MM.

In this regard, the Indian Council of Medical Research (ICMR)  has published several guidelines for doctors, nurses, patients and hospitals treating Covid patients. If you or your family member is diagnosed with Covid, your case doctor will apprise you of these guidelines.

• There are clear Dos and Don’ts, and ‘how to manage’ guidelines for doctors. The doctors can refer to papers published by Indian Journal of Medical Research, Lancet, European Confederation of Medical Mycology and Mycoses Study Group Education and Research Consortium.
• The hospital must pursue a multi-disciplinary approach to treat MM and this must include a ENT Specialist, Maxillofacial or plastic Surgeon, Dentist, Ophthalmologist, Internal Medicine Specialist, Microbiologist, Intensivist, Neurologist and Biochemist.

Healthy people who neither have Covid nor MM must:

• Wear a mask while visiting dusty places, construction sites, landfills and sewage dumps, sewage treatment plants, wet markets (vegetables, fruits, meat and fish markets), old and damp buildings, abandoned or ruined buildings. All these will reduce chances of inhaling or ingesting spores of the Mucor fungus.
• Gardening enthusiasts must wear shoes, long pants, full sleeved shirts and gloves while handling wet soil, moss peat or manure
• Follow good personal hygiene including daily baths with proper scrubbing and the use of soap. People living in hot and humid places like coastal cities can bathe twice a week.

Outlook

 Mucormycosis is a serious condition with a high rate of fatality. If you or any of your family members are diagnosed with Covid or MM, do not panic. Consult a specialist at a reputed hospital. He/she will provide the necessary treatment for quick recovery and rehabilitation.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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