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Traces of this black fungus has found in Delhi and Gujarat is proving to be quite deadly with overall all-cause mortality rate of 54%.


Covid-19 has not only become a pandemic but also a crisis all around the world since 2020. The second wave has engulfed India in a way that there is no escape. If that was not enough, there is a new infection that has been discovered recently. Black Fungus or Mucormycosis is a rare fungal disease that is caused by a group of nods known as mucormycosis, as per the reports by Centres of Disease Control and Prevention.

Those who have contracted this infection resulted in blindness and other serious issues. Mucormycosis is caused to those whose immune system is low. The fungus is contacted via fungal spores. However, CDC said that it is not transferable as compared to coronavirus.

There have been at least 100 cases of black fungus found in Gujarat. Five patients suffering from these diseases have been operated on in Ahmedabad. Mainly these have contracted by the covid-19 patients who have been recently recovered. Medical experts say that the intake of steroids increases and decreases the immunity of the covid-19 patients. Due to this, this infection has been on the rise.

Yesterday, the Union Ministry of Health and Family Affairs has come up with the guidelines for screening, diagnosis and management of the disease. Here are some of the list dos and don’t along with signs and symptoms.


Sign and Symptom 

Mucormycosis frequently infects the sinuses, brain, or lungs. While infection of the oral cavity or brain are the most common forms of mucormycosis, the fungus can also infect other areas of the body such as the gastrointestinal tract, skin, and other organ systems In rare cases, the maxilla may be affected by mucormycosis. The rich blood vessel supply of maxillofacial areas usually prevents fungal infections, although more virulent fungi, such as those responsible for mucormycosis, can often overcome this difficulty.

There are several key signs which point towards mucormycosis. One such sign is fungal invasion into the blood vessels which results in the formation of blood clots and surrounding tissue death due to a loss of blood supply. If the disease involves the brain, then symptoms may include a one-sided headache behind the eyes, facial pain, fevers, nasal congestion that progresses to black discharge, and acute sinusitis along with eye swelling. Affected skin may appear relatively normal during the earliest stages of infection. This skin quickly becomes reddened and may be swollen before eventually turning black due to tissue death. Other forms of mucormycosis may involve the lungs, skin, or be widespread throughout the body; symptoms may also include difficulty breathing, and persistent cough. In cases of tissue death, there may be nausea and vomiting, coughing up blood, and abdominal pain

Predisposition

The person who is susceptible to this infection might suffer from uncontrollable diabetes mellitus, immunosuppression by steroids,co-morbidities – post-transplant/malignancy, voriconazole therapy followed by prolonged ICU stay.

Necessary Dos. 

A person should ensure to maintain his/her blood glucose level and diabetes by having a proper balance diet post covid-19 recovery.

The intake of steroids should be done under medical supervision with correct timing and duration.  The same is the case during the intake of antibiotics.

During oxygen therapy, humidifiers are important. Therefore, it is necessary to use clean and distilled water for it.

Control Hyperglycemia.

 

Necessary Don’ts

Do not ignore the warning of sign and symptoms.

A blocked nose isn’t the only sign of black fungus particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators.

Do not hesitate to consult a doctor or to seek aggressive investigations for detecting any fungal conditions.

Do not miss out on the initial treatment of mucormycosis.

Preventive measures

Wear a mask only if you are going to any construction area.

While gardening, wear shoes, big trousers, a long-sleeved shirt and gloves.

And last but not the least, maintain personal hygiene.

Which doctor should you consult? 

  • Microbiologist
  • Internal Medicine Specialist
  • ENT Specialist
  • Ophthalmologist
  • Biochemist
  • Intensivist Neurologist

Where Mucormycosis Comes From

The fungi that cause mucormycosis live in the environment

Mucormycetes, the group of fungi that cause mucormycosis, are present throughout the environment, particularly in soil and in association with decaying organic matter, such as leaves, compost piles, and animal dung.  They are more common in soil than in air, and in summer and fall than in winter or spring.  Most people come in contact with microscopic fungal spores every day, so it’s probably impossible to completely avoid coming in contact with mucormycetes. These fungi aren’t harmful to most people. However, for people who have weakened immune systems, breathing in mucormycete spores can cause an infection in the lungs or sinuses which can spread to other parts of the body.

Diagnosis

As swabs of tissue or discharge are generally unreliable, the diagnosis of mucormycosis tends to be established with a biopsy specimen of the involved tissue

Treatment

If mucormycosis is suspected, amphotericin B therapy should be immediately administered due to the rapid spread and high mortality rate of the disease. Amphotericin B is usually administered for an additional 4–6 weeks after initial therapy begins to ensure eradication of the infection. Isavuconazole was recently FDA approved to treat invasive aspergillosis and invasive mucormycosis.

After administration of either amphotericin B or posaconazole, surgical removal of the “fungus ball” is indicated. The disease must be monitored carefully for any signs of reemergence.

Surgical therapy can be very drastic, and in some cases of disease involving the nasal cavity and the brain, removal of infected brain tissue may be required. In some cases surgery may be disfiguring because it may involve removal of the palate, nasal cavity, or eye structures. Surgery may be extended to more than one operation. It has been hypothesized that hyperbaric oxygen may be beneficial as an adjunctive therapy because higher oxygen pressure increases the ability of neutrophils to kill the organism.

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