Mucormycosis

A rare but serious fungal infection, known as mucormycosis and colloquially as ‘black fungus’, is being detected relatively frequently among Covid-19 patients in some states. The disease often manifests in the skin and also affects the lungs and the brain. Numbers of mucormycosis cases detected in Delhi, Maharashtra

and Gujarat. Experts in the national Covid-19 task force recently issued an evidence based advisory on the disease. Mucormycosis is a serious but rare fungal infection caused by a group of molds called mucormycetes. These fungi live throughout the environment, particularly in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood. Mucormycosis is the name of the infection, not the fungus. Fungi that most commonly cause mucormycosis Examples are: Rhizopus species, Mucor species, Rhizomucor species, Syncephalastrum species, Cunninghamella bertholletiae, Apophysomyces species, and Lichtheimia species.People get mucormycosis by coming in contact with the fungal spores in the environment. For example, the lung or sinus forms of the infection can occur after someone breathes in spores. These forms of mucormycosis usually occur in people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. Mucormycosis can also develop on the skin after the fungus enters the skin through a cut, scrape, burn, or other type of skin trauma.

Doctors have noted a rise in cases of mucormycosis among people hospitalized or recovering from Covid 19, with some requiring urgent surgery. People get mucormycosis through contact with fungal spores in the environment. For example, the lung or sinus forms of the infection can occur after someone inhales the spores from the air. A skin infection can occur after the fungus enters the skin through a scrape, burn, or other type of skin injury.Usually, mucormycetes do not

pose a major threat to those with a healthy immune system. Mucormycosis can’t spread between people or between people and animals and there is no vaccine to prevent mucormycosis.

Types of mucormycosis:

Rhinocerebral (sinus and brain) mucormycosis is an infection in the sinuses that can spread to the brain. This form of mucormycosis is most common in people with uncontrolled diabetes and in people who have had a kidney transplant.

Pulmonary (lung) mucormycosis is the most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant.

Gastrointestinal mucormycosis is more common among young children

than adults, especially premature and low birth weight infants less than 1 month of age, who have had antibiotics, surgery, or medications that lower the body’s ability to fight germs and sickness. 9-10

Cutaneous (skin) mucormycosis: occurs after the fungi enter the body through a break in the skin (for example, after surgery, a burn, or other type of skin trauma). This is the most common form of mucormycosis among people who do not have weakened immune systems.

Disseminated mucormycosis occurs when the infection spreads through the bloodstream to affect another part of the body. The infection most commonly affects the brain, but also can affect other organs such as thespleen, heart, and skin.

Symptoms of Mucormycosis:

Symptoms of Mucormycosis include pain and redness around the eyes or nose,with fever, headache, coughing, shortness of breath, bloody vomits, nasal

blockade or congestion, nasal discharge (blackish/bloody), one-sided facial pain with swelling, blurred or double vision with pain, worsening of respiratory.

Who will affect with mucormycosis:

Mucormycosis is rare, but it’s more common among people who have health problems or take medicines that lower the body’s ability to fight germs and

sickness. Certain groups of people are more likely to get mucormycosis, including

people with Diabetes, especially with diabetic ketoacidosis, Cancer, Organ transplant, Skin injury due to surgery, burns, or wounds, too much iron in the body, low number of white blood cells and low birthweight.

Prevention to get affected:

1. Try to stay away from the outside environment.

2. Try to avoid areas with a lot of dust.

3. Wear an N95 mask when going outside.

4. Avoid direct contact with outside water.

5. Avoid activities that involve close contact to soil or dust.

6. Wear gloves when handling materials such as soil, moss, or manure

7. Wear shoes, long pants, and a long-sleeved shirt when doing outdoor

activities.

Diagnosis for Mucormycosis:

1. A fluid sample from the respiratory system of a patient, suspected of mucormycosis in lungs or sinuses to send to a laboratory.

2. A tissue biopsy, in which a small sample of affected tissue is analyzed in a laboratory under a microscope or in a fungal culture can detect evidence of mucormycosis.

3. A CT scan of your lungs, sinuses, or other parts of your body, depending on the location of the suspected infection.

How is mucormycosis treated

Mucormycosis is a serious infection and needs to be treated with prescription antifungal medicine, usually amphotericin B, posaconazole, or isavuconazole. In

some cases, it can require surgery; it can lead to eventual loss of the upper jaw and sometimes even an eye.

Deaths due to mucormycosis:

Mucormycosis is frequently a life-threatening infection. A review of published mucormycosis cases found an overall all-cause mortality rate of 54%. 8 The mortality rate varied depending on underlying patient condition, type of fungus, and body site

affected.

The Indian Council of Medical Research and the Union Health Ministry have issued an advisory urging people to wear shoes, long trousers, long sleeve shirts and gloves while handling soil, moss or manure. People should also maintain personal hygiene,

ensure if they have diabetes that it is well controlled, and medical professionals shoul discontinue immune-suppressing drugs such as steroids as soon as they are able.

Courtesy:

Centre for Disease control and Prevention, Indian Express, Times of India and BBC.