WHAT IS BLACK FUNGUS?

Mucormycosis or black fungus is a complication caused by a fungal infection. The disease is being
detected among patients who are recovering or have recovered from Covid. Moreover, anyone who
is diabetic and whose immune system is not functioning well needs to be on guard against this

• Mucormycosis is commonly known as a black fungus found in soil and on wet surfaces.
• Is rare but is now seen in Covid and post-Covid patients.
• Affects the nose, eye, brain, lungs.
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WHY SPREAD OF BLACK FUNGUS IS ON RISING

Though most doctors feel mucormycosis was triggered by the unregulated use of medicines on Covid patients without controlling blood sugar level, several others felt that post-Covid unhygienic lifestyle at home too paved the way for the black fungus to afflict immunosuppressed health systems.

SYMPTOMS

Mucormycosis begins to manifest as a skin infection in the air pockets located behind our forehead, nose, cheekbones, and in between eyes and teeth. It then spreads to the eyes, lungs and can even spread to the brain. It leads to blackening or discoloration over the nose, blurred or double vision, chest pain, breathing difficulties, and coughing of blood.

• It can occur in patients with Covid-19 infection (active/recovering/post-discharge).
• There can be nasal discharge, facial/eye/jaw pain, swelling, headache, toothache, loosening of teeth, fever.
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PATIENTS AT HIGH RISK

• Immuno-suppression by steroids - Those on high dosages of steroids for more than 25 days
• Uncontrolled diabetes - Diabetic patients with poorly controlled blood sugar.
• Immuno-compromised patients like HIV, cancer, and other auto immune disorders.
• Prolonged ICU stay
• Co-morbidities-post transplant/ malignancy.
• Voriconazole therapy (Used to treat serious fungal infections)
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WHEN TO SUSPECT

• SINUSITIS: Nasal congestion, nasal discharge (blackish/bloody), local pain on the cheekbone.
• One-sided facial pain, numbness, or swelling.
• Blackish discoloration over the bridge of nose/palate
• Toothache, loosening of teeth, jaw involvement
• Blurred or double vision with pain; fever, skin lesions, thrombosis, and necrosis
• Chest pain, pleural effusion, hemoptysis

HOW IS IT TREATED?

While the infection may just begin with a skin infection, it can spread to other parts of the body. Treatment
involves surgically removing all dead and infected tissue. In some patients, this may result in loss of the upper jaw or sometimes even the eye. The cure may also involve a 4-6 week course of intravenous anti-fungal therapy.
Since it affects various parts of the body, treatment requires a team of microbiologists, internal medicine
specialists, intensivist neurologists, ENT specialists, ophthalmologists, dentists, surgeons, and others

DIAGNOSIS

• MRI-PNS (paranasal sinuses) with brain contrast study

TREATMENT

• Control of diabetes
• Reduce steroids
• Reduce immunosuppressive drugs
• Surgery

PREVENTIONS:

• Control diabetes - Good sugar control
• Reduce steroids - Use of steroids only in patients with low saturation of oxygen
• Maintain adequate systemic hydration
• Covid-appropriate behavior like wearing a mask
• Wear shoes, long trousers, long sleeve shirts, and gloves while handling soil (gardening)
• Maintain personal hygiene including scrub bath.

HOW TO MANAGE THE DISEASE

• Infuse normal saline (IV) before amphotericin B infusion.
• Anti-fungal therapy for at least 4 to 6 weeks

DO'S

• Control hyperglycemia
• Monitor blood glucose level post-Covid
• Use steroids judiciously - correct time, dose, and duration
• Use clean sterile water for humidifiers during oxygen therapy
• Use antibiotics/antifungals judiciously.

DONT'S

• Don't miss warning signs and symptoms
• Don't consider all blocked nose cases as bacterial sinusitis, especially in the context of immunosuppression / Covid 19 patient immunomodulators.
• Do not hesitate to seek aggressive medical investigations
• Do not lose time to initiate mucormycosis treatment.

MYTHS

• Spreads from one person to another person
• Spreads by oxygenation, humidifier, or water.