New Delhi: Mucormycosis, a fungal infection, being found in COVID-19 patients with compromised immunity is resulting in disfiguration and in some cases, it is proving to be fatal. Mucormycosis is a fungal infection that mainly affects people on medication for other health problems that reduces their ability to fight environmental pathogens, according to the Indian Council of Medical Research (ICMR). But, according to Union Health Minister, Dr Harsh Vardhan awareness and early diagnosis can help curb the spread of the fungal infection. So, what are the symptoms of Mucormycosis or black fungus and what is the treatment? Experts answer all.
What Is Mucormycosis And Who Is At A Higher Risk?
Mucormycosis is a kind of a fungal infection. It is not a new fungus; it is there in the natural atmosphere and found in soil, manure, decaying fruits and vegetables. Since we are all healthy people whose immune system is able to fight this, we don’t get the illness. But people who have had COVID, some people who have got uncontrolled diabetes and people who are on certain medications like for cancer treatment, they are the ones who are at a high risk, explained Dr Girija Suresh, Senior Opthalmic Consultant, Fortis Hospital Mulund.
— Dr Harsh Vardhan (@drharshvardhan) May 14, 2021
As per ICMR, the five conditions that predispose an individual to mucormycosis are:
– Uncontrolled diabetes mellitus
– Immunosuppression by steroids
– Prolonged ICU stay
– Co-morbidities – post transplant/malignancy
– Voriconazole therapy
What Are The Symptoms Of Mucormycosis?
Pain and redness around eyes and/or nose, fever, headache, coughing, shortness of breath, bloody vomits, and altered mental status are the signs and symptoms of mucormycosis, as per ICMR. Additionally, COVID-19 patients, diabetics or immunosuppressed individuals should look out for the following signs:
– Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheekbone
– One-sided facial pain, numbness or swelling
– Blackish discoloration over bridge of nose/palate
– Toothache, loosening of teeth, jaw involvement
– Blurred or double vision with pain; fever, skin lesion; thrombosis (blockage of blood vessels) and necrosis (death of tissues due to lack of blood)
– Chest pain, pleural effusion (fluid fillling in the covering of lungs), haemoptysis (coughing out blood), worsening of respiratory symptoms
Which Parts Of The Body Does It Attack?
Dr Satish Nair, ENT, Apollo Hospitals, Bannerghatta, explained that the fungal infection starts from the nose and later it affects the eyes and brain. It can also directly affect the brain which can be fatal, said Dr Nair. He added,
Nose and paranasal sinuses are in close relation to the eye and brain and any infection has the ability to invade these areas if not treated. The problem with the fungal infection begins when it invades into the blood vessel. Through blood vessels, the infection spreads faster and can also block a blood vessel resulting in complete loss of blood supply to an area.
Why Are COVID-19 Patients Contracting Mucormycosis Now?
Dr Nair reiterated that mucormycosis existed even before the COVID-19 pandemic. However, back then they would get two to three cases in a year that too in patients who are severely diabetic. But, now, in the last 10 days, Dr Nair has got 20 cases. Giving out the reason for the same, Dr Nair said,
One reason is that there is an increase in COVID-19 cases in general as a result of which more cases of black fungus are being reported. Secondly, moderate and severe COVID-19 patients are often treated with steroids. And if a diabetic patient is given steroids as part of COVID-19 treatment, it increases the blood sugar level which can result in complications. Hence, it is important to manage the use of steroids and control sugar. Thirdly, most of the patients are also on high-level anti-biotics. These anti-biotics take away any competing organism; they take away all the bacteria as a result of which fungus gets all the way to travel in the body.
How To Prevent And Treat Mucormycosis?
Dr Girija Suresh says it’s important to follow all COVID precautions, especially wearing a mask, even after recovering from COVID-19 because low immunity can last for three months after recovery. During the recovery phase, one might inhale fungal spores from the air.
It is generally contracted by inhalation and touching objects and then touching nose, mouth and other body parts. Follow the same precautions you do for COVID-19, said Dr Suresh.
As per ICMR, the dos to prevent mucormycosis are preventing high sugar levels; monitoring blood glucose levels post COVID-19 discharge; judicious use of steroids, antibiotics and anti-fungals; using clean, sterile water for humidifiers during oxygen therapy.
ICMR suggests against considering all the cases with a blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunotherapy.
Adding to this, Dr Nair said, early diagnosis is the key. He believes, over the past few weeks, awareness among people has increased and now patients are coming at an earlier stage. He added,
If the infection is at the sinus level, the patient can be treated. Once it reaches the eyes, we have to see the damage it has caused; sometimes vision is involved and we may have to remove eye. The treatment has always been surgical debridement that is removing all the fungal material. Another option is anti-fungal medication.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.
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