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Black fungus in Covid patients – Awareness is the key

Dr.Jyotirmay S Hegde, Consultant ENT & Skullbase Surgeon, Columbia Asia Hospital, Whitefield (A unit of Manipal Hospitals)

The various manifestation of Covid 19 virus has further raised concerns among the public. Sometimes, this virus can affect an individual without showing symptoms, and in few cases, people may face severe health complications like high fever, breathing problems, drop-in oxygen saturation, and even pneumonia. Mucormycosis or commonly called black fungus is one such condition due to Covid 19 which is rising alarmingly among patients who have tested positive for the virus and recovered from it.
There has been a steady increase in the number of black fungus cases in the last few days. If this condition is not detected and treated at an early stage, it can rapidly spread to the other parts of the body like the eyes and brain and cause loss of vision and at times even fatal. Moreover, the reduced availability of antifungal medicines like Amphotericin –B has further complicated the situation. Reason for the spike in numbers People suffering from Covid 19 tend to the immune system that is compromised. Covid positive patients who are critically ill or have severe symptoms are given steroids which is the lifesaving treatment for them. Steroids reduce inflammation in the lungs for Covid-19 patients and appear to help stop some of the damage the infection can create to the body. Covid 19 patients who are taking steroids as part of their treatment are particularly at risk of developing black fungus because steroids further suppress the immune system. A combination of Covid 19, uncontrolled diabetes or other comorbid conditions, and steroids adds fuel to the fire and increases the chances for black fungus. Therefore, it is important to avoid taking any over-the-counter medications without a prescription and steroids need to be used judiciously.
Mucormycosis – the black fungus
Mucormycosis is a rare fungal infection that affects the sinuses, the brain, and lungs. A group of molds called micromycetes which are naturally present in the environment cause this. These fungi are present in the soil, decaying leaves, compost piles, and animal dung. Though one can contract this by breathing the mold spores in the air, the risk increases with a weakened immunity system.
Mucormycosis can cause severe complications in people who have uncontrolled diabetes or individuals who are severely immunocompromised like cancer patients or people with reduced immunity. Mucormycosis is a rare and non-contagious infection. However, it can be debilitating or fatal if it is not diagnosed and treated in time.
Warning signs and symptoms to watch out for:

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  • One-side facial pain or numbness
  • Blackish discoloration over the bridge of the nose or palate
  • Toothache
  • Blurred or double vision with pain
  • Skin lesion
  • Thrombosis
  • Chest pain
  • Worsening respiratory symptoms
  • Altered mental status

Who has to be more cautious?

Mucormycosis mainly affects individuals who have low immunity, especially patients who have had a prolonged admission to the ICU. Recently, this infection is mostly seen in people who have tested positive for Covid 19 and on steroids coupled with other comorbidities like uncontrolled diabetes, cancer, kidney failure, heart failure, etc? Age and high ferritin levels in the blood can also add to the complication. Black fungus generally does not pose threat to individuals who have a functional immune system.

How does it spread?

Though black fungus is not transmissible, it can pose danger to the affected person as it spreads rapidly throughout the body. If left untreated, it can spread to the brain and lungs causing complications like brain infection, paralysis, seizure, pneumonia, and in severe cases can be fatal.

As the black fungus is a rare condition, the first wave of Covid 19 brought focus on this and emphasized the immediate treatment to curb the spread of the fungus to other parts of the body. However, in the second wave, there is a sudden spike in cases and many states now have been reporting mucormycosis cases. Is mucormycosis treatable? Mucormycosis can be treated with surgical intervention and using antifungal medications. Along with this, managing diabetes, discontinuing the immunomodulating drugs, and reducing the intake of steroids also helps. Prevention of mucormycosis In general self-care measures are the best way to avoid this infection. Especially people with weakened immune systems need to be careful of their condition and the medicine intake. Safeguarding themselves from the Covid infection is more important. Below are a few tips to prevent mucormycosis:

Follow Covid 19 protocols of wearing masks, washing hands, and maintaining social
    • Keep diabetes under control
    •  Monitor blood glucose level post-Covid-19 discharge
    • Use steroid judiciously – correct timing, correct dose, and duration
    •  Use clean, sterile water for humidifiers during oxygen therapy
    • Use antibiotics/antifungals medicines judiciously
    •  Do not miss warning signs and symptoms particularly in the context of immunosuppression and/or Covid-19 patients on immunomodulators Taking precautions is the best way to keep away from infections.

However, even if an individual contract the infection, identifying the symptoms and taking immediate medical help always aids in treating it effectively.

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