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Black Fungus & Covid-19 | What is Mucormycosis?

Featured | Mucormycosis


Zygomycosis, now known as Mucormycosis or black fungus is a serious but rare fungal infection. It is caused by a group of moulds (also called molds) called mucormycetes. These murcormycetes are found in leaves, rotting wood, piles of compost, and soil.


Whom does this infection affect the most?


Whom | Mucormycosis


Although they are naturally present in the environment but they do not affect all people, which doesn’t mean it is not dangerous and life-threatening for people. People infected by Mucormycosis are mostly those who have been recovered from Covid-19, having health issues, and are on medicines that lower the ability of the body to fight germs and sickness.


What causes Mucormycosis?


Fungal spores are microscopic biological particles that are inhaled from the air and hence Mucormycosis affects the lungs or sinuses. It can occur on the skin after the fungus enters the skin through a cut, burn, or any skin injury.  Mucormycosis is not contagious, so you can’t get it from an infected person.


Mucormycosis can be broadly classified into 5 types:


1) Rhinocerebral mucormycosis:


This is an infection in the sinus that reaches the brain. It is caused by saprophytic fungi. People with uncontrolled diabetes and a history of kidney transplants are the most vulnerable to this infection.


Symptoms: One-sided face swelling, headache, congestion in nose and sinus, and fever.


2) Pulmonary mucormycosis:


It is mostly found in people with cancer and those who’ve had an organ or stem transplant.  It has a fraction of 23% among all the other types of mucormycosis. Its mortality rate varies between 40-76%.


Symptoms: Fever, cough, chest pain, Breathlessness.


3) Gastrointestinal mucormycosis:


This infection is seen mostly in young children, Premature and underweight infants who’ve had a lot of medications lowering their ability to fight the germs and bad immune system.


Symptoms: Abdominal pain, nausea, and vomiting, gastrointestinal bleeding


4) Cutaneous mucormycosis:


It is caused when the fungi enter the skin via cuts, burns, or any other skin trauma. This is the most common form of Mucormycosis among people with a good immune system. The infection spreads rapidly from the skin to the tissue and bone. Biopsies are done in order to diagnose it.


Symptoms: Pain, blisters on the skin, Infected area turning black, etc.


5) Disseminated mucormycosis:


When the infection spreads through the bloodstream to affect other parts of the body like the heart, skin, and brain, it is known as Disseminated mucormycosis. Its mortality rate is approximately 100%, but treatments have been reported.


Symptoms: Mental situation changing, coma.


How is Mucormycosis diagnosed?


• How is Mucormycosis diagnosed?


The ability to diagnose mucormycosis depends on imaging technology and well-trained staff. Patients suspected of having mucormycosis should be referred to the center immediately.


The only way to diagnose this fungal infection is by carefully looking at the symptoms, looking for the patient’s medical background and history, and by performing specialized medical tests.


It can be tough to identify this infection as its symptoms are common with many other conditions. Diagnosis can be done via a test known as fungal culture.


A fungal culture is a procedure used to find out whether fungi are present in a certain body part.


Mold is identified in a certain tissue and then this fungal culture test is performed to confirm it. It is diagnosed by looking at the sample of tissue in labs.


Samples of phlegm or nasal discharge in case of sinus infection. ENT (ear, nose, and throat) endoscopy is performed and repeated to ensure the response of the treatment. Pulmonary biopsies are performed based on the radiological findings obtained by CT scans.


The treatment should be started at its earliest to reduce the mortality rate. It should be fast and aggressive as already in most cases patients suffer from tissue damages by the time this infection is diagnosed. No particular biomarkers have been identified for Mucormycosis as of now.


Medication and treatment:


Medication & Treatment | Mucormycosis


Medication plays two of the very important roles. The antifungal medications halts or slowdowns the fungal spread in the body while the other medications treat any debilitating diseases.


1) Amphotericin B (initially intravenous) is the usual drug of choice for antifungal treatment.


2) Posaconazole or Isavuconazole may also treat mucormycosis.


Amphotericin B is given through a vein whereas Posaconazole, Isavuconazole can be given through a vein or mouth.


Following are some therapies for the treatment of mucormycosis:


1) Antifungal therapy:


The early introduction of anti-fungal therapies to the patients improves the consequences of the infection. Anti-fungal drugs are used to treat mucormycosis.


2) Adjunctive therapy:


Reversal of immunosuppression is a crucial pillar of remedy for mucormycosis, at the side of surgical procedure and suitable early antifungal agents. Most sufferers who die of this sickness have bad healing of bone marrow features or require extended immunosuppressive remedies.


3) Salvage therapy: 


If an affected person fails to reply to traditional treatment for invasive mucormycosis which incorporates early starting of IV amphotericin B, surgical debridement of the necrotic tissue as quickly because the prognosis is confirmed, isavuconazole is preferred.


There is no standard time as to when the treatment of mucormycosis would be completed. The speed of diagnosis, treatment, and recovery depends upon the overall health of the patient and how is his body reacting to it.


Related Article: All you need to know about Corona Vaccine


What Research has to say about it?


Research | Mucormycosis


In research, 4 out of 5 cases of Mucormycosis are found in people with a weak immune system and the most common type was rhino-cerebral and rhino-orbital. The mortality rate of this infection is very high.


The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Mucormycosis is usually a life-threatening infection.


A review of published cases of mucormycosis revealed that the overall mortality rate was 54%. The mortality rate for people with a sinus infection is 46%, 76% with pulmonary mucormycosis, and 96% of disseminated mucormycosis.


Final Words: 


Even after early diagnosis and active medical and surgical treatment, the prognosis of recovery from mucormycosis is still very poor. In recent years, many new methods for the treatment of mucormycosis have emerged. Amphotericin lipid is currently the first-line drug of choice for the treatment of mucormycosis.

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