Black Fungus

Mucormycosis is a deadly fungal infection found in some Covid-19 patients with uncontrolled diabetes and prolonged intensive care unit (ICU) stay. The infection which is also known as “Black Fungus” affects the brain and the lungs. It is a rare but dangerous fungal infection caused by a group of moulds known as mucormycetes, which are present naturally in the environment. They only cause serious complications when a patient has pre-existing health problems or has taken medication that compromises the immune system. The fungal spores commonly enter through inhalation and affect the sinuses or lungs. They can also enter through an open cut or wound and infect the skin.

Warning symptoms include pain and redness around eyes and nose, fever, headache, coughing, shortness of breath, bloody vomits and altered mental status, stated the government advisory. In Covid-19 patients with diabetes and immunosuppressed individuals, one must suspect Mucormycosis if there is:

Sinusitis, nasal blockage and congestion
One sided facial pain or numbness
Blackish discoloration over the bridge of the nose or palette
Toothache
Blurred or double vision with pain
Skin lesion
Thrombosis
Chest pain and worsening respiratory symptoms

Major risk factors for this disease include uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, malignancy and voriconazole therapy, the ICMR health ministry advisory stated.

Mucormycosis can be treated with antifungal drugs but can eventually require surgery. As per experts, controlling diabetes is of utmost importance, reduce steroid use and discontinue the immunomodulating drugs.

As per the government advisory, medical treatments include installing peripherally inserted central catheter, maintaining adequate systemic hydration, infusion of normal saline intravenously before Amphotericin B infusion and antifungal therapy for at least six weeks besides monitoring the patient clinically with radio imaging for response and to detect disease progression

To prevent the disease, blood glucose level should be monitored post Covid discharge and also ij diabitic patients, steroids should be used judiciously in correct timing, dose and duration, clean sterile water should be used in humidifiers during oxygen therapy, and antibiotics and antifungal medicines should be used correctly.

The disease can be managed by controlling diabetes, discontinuing immunomodulating drugs, reducing steroids and extensive surgical debridement to remove all necrotic materials, according to the advisor