COVID-19 And Mucormycosis (Black Fungus): ICMR Releases Guidelines; Do’s And Don’ts

Amid the coronavirus pandemic, an increase in mucormycosis or black fungus has been recorded among patients. Mucormycosis, also known as black fungus, can turn dangerous if left untreated [1].

Previously, doctors at a hospital in Delhi had found multiple cases of a deadly fungal infection “triggered by COVID-19” in recovering COVID-19 patients, due to which nearly half of them lost their eyesight.

The government and health organizations are working towards containing this black fungus outbreak due to the added burden on the health of COVID-19 patients. The mortality rate of mucormycosis or black fungus is said to be 50 per cent.

COVID-19 Triggered Mucormycosis: Everything You Need To Know

COVID-19 And Mucormycosis: Everything You Need To Know

As reports had previously suggested, the infection is rare but not a new one. Mucormycosis, previously called zygomycosis, is a severe but rare fungal infection caused by a group of moulds called mucormycetes [2]. However, mucormycosis triggered by COVID-19 indeed is a new one.

Mucormycosis can result in an acute, rapidly advancing, and occasionally fatal disease and are diagnosed relatively infrequently. The primary symptom of this fungal infection is a respiratory or a skin infection. Symptoms of a related respiratory disorder may include cough, fever, headache, nasal congestion, and sinus pain [3]. One of the other primary symptoms includes compromised vision [4].

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A few districts in Maharashtra reported the first instances of the disease, observed mostly in COVID-19 patients [5]. But now cases have been reported from Karnataka, Uttarakhand, Telangana, Madhya Pradesh, Andhra Pradesh, Haryana, Bihar and other states.

Maharashtra has reported over 1500 cases and 90 fatalities from the disease, who are all COVID survivors. By Thursday, Haryana had reported 226 cases and Telangana 80, and high numbers also came in from Gujarat and Madhya Pradesh [6].

Who Are Contracting Mucormycosis?

According to reports, COVID-19 patients undergoing oxygen therapy in ICU, where a humidifier is used, are prone to fungal infections because of exposure to moisture. In addition to that, health conditions such as uncontrolled diabetes, weakening of the immune system due to steroids, prolonged ICU or hospital stay, voriconazole therapy used to treat serious fungal infections in COVID-19 patients can increase the risk of mucormycosis [7].

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The symptoms specific to Covid-19 triggered mucormycosis are face numbness, one-side nose obstructions or swelling of eyes, or pain. Mortality has been reported in the range of 50 per cent (five patients), and 50 per cent of the patients have lost their eyesight permanently and required critical care support due to associated complications [8].

What Is The Treatment For Mucormycosis?

The treatment of black fungus infection requires a multi-disciplinary approach consisting of eye surgeons, ENT specialists, general surgeons, neurosurgeons and dental maxillofacial surgeons, and the institution of the Amphotericin-B injection as an antifungal medicine [9].

Recently, Union Health Minister Harsh Vardhan put out a tweet that focused on informing people about the definition, symptoms, risk factors, and do’s and don’ts of mucormycosis [10].

Mucormycosis Do’s And Don’ts

Do’s

• Control hyperglycaemia or high blood sugar levels
• Monitor blood glucose level post-COVID-19 discharge and also in diabetics
• Use steroid judiciously
• Use clean, sterile water for humidifiers during oxygen therapy
• Use antibiotics/antifungals judiciously

Don’ts

• Do not miss warning signs and symptoms (such as abnormal black discharge or crusty dryness, or bleeding from the nose, nasal blockage, swelling around the eyes, facial numbness or tingling, loosening of teeth etc.)
• Do not consider all the cases with a blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
• Do not hesitate to seek aggressive investigations, as appropriate (KOH staining and microscopy, culture, MALDITOF), for detecting fungal aetiology
• Do not lose crucial time to initiate treatment for mucormycosis

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Preventive Measures To Avoid Contracting Mucormycosis

• Eat a balanced diet to boost immunity.
• Always wear a mask and wear long clothes and have less exposure to skin.
• Be mindful and vigilant about your health and medications (especially if you are taking steroids).
• Avoid outdoor activities involving mud, moss, manure, or soil without covering your body.

On A Final Note…

According to experts, awareness and early diagnosis can help curb the spread of fungal infection. The Centre on Thursday urged states to declare Black Fungus an epidemic by making it a notifiable disease under the Epidemic Diseases Act 1897.

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