What is ‘Black Fungus’, the deadly rare fungal infection in India.

Black Fungus, a rare disease, witnessing an upsurge in our country due to the existing disastrous pandemic. Cases of black fungus are rapidly increasing in India, especially amidst COVID-19 survivors, causing serious illness and deaths. The Government of India has therefore requested states to make it a notifiable disease.

Black fungus under microscope.

What is Black Fungus Or Mucormycosis?

Mucormycosis(previously known as Zygomycosis) is a rare fungal infection caused by a group of molds called mucormycetes. The pores of this fungus are found in soil, organic matter, air, and sometimes also in food therefore they live throughout the environment. It affects people when they come in contact with the fungal spores in the environment. They enter the body through the nose, mouth, or eyes and can affect the brain. If not treated on time. This infection usually occurs in people who have health problems or due to the intake of medicines that damage our immune system’s ability to fight germs and sickness.

Types of Black fungus or mucormycosis

Rhinocerebal mucormycosis:

Also known as sinus and brain mucormycosis. It causes infection in the sinuses and can spread to the brain. It is most common in diabetic patients, patients on immunosuppressants as seen with organ recipients and haematologic stem cell recipients.

Symptoms

1. Facial deformation

2. Facial pain

3. Nasal congestion

4. Black lesions on nasal bridge or upper side of the mouth

5. Fever

Headache

2. Pulmonary mucormycosis:

Also known as lung mucormycosis. People usually get infected due to the inhalation of spores present in the environment. It is most common in cancer patients and in those who have had an organ transplant or a stem cell transplant.

Symptoms

1. Chest pain
2. Cough
3. Fever
4. Shortness of breath

3. Gastrointestinal mucormycosis:

It can occur due to the intake of bad quality food. As the ubiquitous organisms responsible for the infection can be found in decaying vegetation and soil. It is more common among young children than adults, especially premature and newborns with low birth weight.

Symptoms

1. Abdominal pain
2. Nausea and vomiting
3. Gastrointestinal bleeding

4. Cutaneous mucormycosis:

Also known as skin mucormycosis. It occurs in the body through a break in the skin, for example, after surgery, a burn, or other types of skin trauma.

Symptoms

1. It may look like blister or ulcers
2. The infected area may turn black

5. Disseminated mucormycosis:

It occurs when the infection spreads through the bloodstream to affect another part of the body. It most commonly affects the brain along with other organs like the spleen, heart, and skin.

Symptoms

1. Loss or pain in vision
2. Toothache, loosening of teeth
3. Altered mental status, confusion

Symptoms of black fungus

How the infection is related to Covid-19?

Usually, our body’s immune system successfully fights against infections like mucormycosis. But, when a patient is diagnosed with Covid-19, it involves the intake of drugs like steroids, which suppresses our immunity response and increases blood sugar level. As a result, in a post-Covid-19 scenario, patients have a weakness, and they face a life-threatening risk of getting infected by infections like mucormycosis.

Also, Covid patients undergoing oxygen therapy in ICU, where a humidifier is used, are prone to fungal infection because of exposure to moisture.

Don’t panic, this does not mean that every Covid patient will get infected by mucormycosis. It is most common in diabetic patients and who have had surgery or any other health problem. Mucormycosis is not fatal if treated on time but, delay in diagnosis can turn out to be a real trauma.

Do’s and Don’ts

Who is at more risk?

Black Fungus or Mucormycosis can infect people with the following shortcomings easily:

1. Diabetes, especially with diabetic ketoacidosis
2. Cancer
3. Organ transplant
4. No oral care
5. Stem cell transplant
6. Neutropenia
7. No nasal care
8. Long-term corticosteroid use
9. Injection drug use
10. Hemochromatosis (excess of iron)
11. Skin injury due to surgery, burns, or wounds
12. Lack of hygiene
13. Pre-maturity and low birth weight

Chances of getting Covid and mucormycosis both?

According to the ICMR, Covid-19 patients are at a higher risk of black fungus infections. These include patients who were taking steroids during treatment and were in the ICU for a long time at the hospital. Reports have also claimed that a covid patient can also fall victim to this rare fungal infection.

Also, certain reports claim that other existing comorbidities like HIV, organ transplant, and other things can lead to a situation where Covid patients could get infected with mucormycosis also.

The situation in India and what governments are doing?

1. “The exact burden is not known. The states are reporting very high numbers — some 400–500, a few even 1,000,” VK Paul, member of government think tank Niti Aayog.
2. Till now, no official data has been released by the central government.
3. The government has ordered ICMR to collect the data from the states.
4. Rajasthan government has declared ‘black fungus’ an epidemic.
5. Karnataka and a few other state governments have declared ‘black fungus’ a notifiable disease.
6. Karnataka setups a dedicated facility in Bengaluru and identities regional centers in six districts.
7. Center to help state government over ‘black fungus’ infection, assuring the fulfillment of injections and other drugs.

The Final Verdict

Black fungus or mucormycosis, rare infection, but due to Covid could become disastrous. But if we will show more patience and discipline with a positive approach, following all the norms framed by the government, we can defeat this infection.

Our safety lies in our hands. As this infection has many entry points, follow all the do’s and don’ts, live a hygienic life. One should do oral care and nasal care.

“Time will come, we will win this together, we will meet again”

Stay home, stay safe. Wear a mask.

by Abhishek Dubey