Even as people are trying their best to protect themselves from and cope with Covid-19, the government warns of the looming threat of a fungal infection Mucormycosis, or Black Fungus. The fungal infection is being reported in a few Covid-19 patients during or post-recovery. As per a statement of the Maharashtra Health Minister two days ago, over 2000 people had already been affected by this fungal infection in the state and 10 people had even succumbed to it and few patients even lost their eyesight.

What causes Mucormycosis aka Black Fungus?

Mucormycosis or black fungus is a complication caused by a fungal infection. People catch mucormycosis by coming in contact with the fungal spores in the environment. It can also develop on the skin after the fungus enters the skin through a cut, scrape, burn, or other types of skin trauma. The disease is being detected among patients who are recovering or have recovered from Covid-19. Moreover, anyone who is diabetic and whose immune system is not functioning well needs to be on the guard against Mucormycosis, The Union Ministry of Health and Family Welfare (MoHFW) said.

According to an advisory issued by the Indian Council of Medical Research (ICMR), these conditions in Covid-19 patients increase the risk of mucormycosis infection:

• Uncontrolled diabetes
• Weakening of immune system due to use of steroids
• Prolonged ICU / hospital stay
• Co-morbidities / post organ transplant / cancer
• Voriconazole therapy (used to treat serious fungal infections)

How it is related to Covid-19

The disease is caused by a set of micro-organisms known as Mucormycetes, which are present naturally in the environment, seen mostly in soil and in decaying organic matter like leaves, compost, and piles.

In the normal course, the human body’s immune system successfully fights such fungal infections. However, Covid-19 affects the immune system, besides the treatment of Covid-19 patients involves the intake of drugs like Dexamethasone, which suppresses immune system response. Due to these factors, Covid-19 patients face a renewed risk of failing the battle against attacks mounted by organisms such as Mucormycetes.

In addition, Covid patients undergoing oxygen therapy in ICU, where the humidifier is used, are prone to fungal infection because of exposure to moisture.

But this does not mean that every Covid patient will get infected by Mucormycosis. The disease is uncommon in those not having diabetes but can be fatal if not treated promptly. Chances of recovery depend upon early diagnosis and treatment.

What are the Common Symptoms?

Mucormycosis begins to manifest as skin infection in the air pockets located behind the forehead, nose, cheekbones, and in between the 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.

ICMR has advised that not all cases of blocked nose should be considered as cases of bacterial sinusitis, particularly during or after the treatment of Covid-19 patients. One must seek medical help for detecting fungal infection.

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 weeks 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.

Controlling diabetes is one of the foremost prevention methods suggested by ICMR. Hence, Covid-19 patients who are diabetic need to take utmost care.

Self-medication and over-dosage of steroids can result in fatal events and hence doctor’s prescription should be strictly followed. Speaking about the adverse effects of inappropriate use of steroids, Member (Health), NITI Aayog, Dr VK Paul says: “Steroids should never be administered at an early stage of Covid-19. It should be taken only after the sixth day of infection. Patients should stick to appropriate doses of the drugs and take the drug for a specific number of days as advised by the doctors. Rational use of medicines should be ensured to avoid adverse side effects of the drug.”

“Other than steroids, use of Covid-19 drugs such as Tocilizumob, Itolizumab also suppresses the immune system. And when these drugs are not used appropriately, it increases the risk, as our immune system fails to fight the fungal infection.” Dr Paul adds.

ICMR in its guidelines has also advised Covid-19 patients to discontinue immunomodulating drugs, a substance that stimulates or suppresses the immune system. The National COVID-19 Task Force has revised the dosage of Tocilizumab to prevent any such adverse effects. Maintaining proper hygiene can also help keep the fungal infection away.

For patients on oxygen therapy, it should be ensured that the water in the humidifier is clean and is refilled regularly. Attention should be paid to ensure there is no leakage of water (to avoid wet surfaces where the fungus can breed). Patients should maintain proper hygiene by keeping their hands as well as a body clean.

Be on Guard after Covid Recovery as well

After recovering from Covid-19, one should closely monitor and should not miss any warning signs and symptoms, as the fungal infection is found to emerge even weeks or months after recovery. One should make judicial use of steroids as per the doctor’s advice to avoid the risk of infection. Early detection of the disease can ease the treatment of the fungal infection.

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