Black Fungus, medically termed Mucormycosis is a fungal infection that is very uncommon in human beings. However, studies have revealed that this infection is caused when a victim is exposed to mucor mould that usually exists on decomposed vegetables or fruits, on plants on manure, soil and air. Surprisingly it may also be present in the mucus and the nasal cavity of a healthy individual without infecting him.
Persons affected: Black Fungus is believed to pose a serious threat and could be fatal to diabetic people who have persistently elevated blood glucose levels, diabetic ketoacidosis, reduced level of leukocytes in the bloodstream ( the cells that built up the immune system), cancer patients, excess iron in the blood, patients who have undergone organ transplants, chronic Kidney disease patients, patients who are under long-term immunosuppressants or steroids, prolonged ICU stays, and HIV victims. In general, persons of all ages may fall prey to this infection, including premature infants.
Recent studies have shown that severely affected covid-19 patients undergoing treatment or who have just recovered fall under the same danger zone. Diabetic persons suffering from Covid-19 are at a higher risk to acquire the deadly Black fungus infection.
In other words, this infection only targets people who are on long term medication for any comorbidities and have very low immunity, decreasing their capacity to fight back the common pathogens present in the air. Conversely, people with a healthy immune system do not have any threat with Black Fungus.
This fungal infection first infects the sinus and, if not medically managed, proceeds to the lungs and brain, which may need surgical intervention and could be fatal for some. According to the statistics, this fungal infection has a very high mortality rate of 50%.
Mode of Transmission: This fungal infection is spread mainly through inhalation of spores of molds belonging to the order of Mucorales and consuming contaminated foods. These spores can also infect open wounds in an individual. Black Fungus is not transmitted from one person to another. In other words, it is not contagious.
Types: Mucormycosis is classified under headings based on the body parts it infects.
1) Rhinocerebral- Uncontrolled diabetes leads to this, which affects the sinus and brain.
2) Gastrointestinal- affects premature and infants with low birth weight, who were subjected to medication that reduces the immunity system.
3) Cutaneous- Affects people with skin injury, leukaemia, uncontrolled diabetes, Graft-versus-host disease, burns injury, intravenous drug usage and HIV patients.
4) Pulmonary- affects cancer patients or people who have undergone an organ transplant or stem cell transplant.
5) Disseminated- This occurs when the infection is carried to other organs by the blood.
6) Kidney- Affects the kidneys.
Symptoms: The most common symptoms during the infection are fever, headache, difficulty breathing, coughing redness around the nose and eyes, which may be painful. Some may vomit blood at times, and some experience disruption in their brain functions. According to the advisory, the following protocol for suspecting a person is infected with Black Fungus is given below.
a) The victim may suffer from blurred vision with one eye swollen due to pain.
b) The teeth become loose involving the jaw.
c) The palate or the bridge of the nose tends to become blackish.
d) The victim suffers from sinusitis with nasal blockage and discharge that may be blackish containing blood.
e) Pleural effusion or water in the lungs, severe respiratory problems associated with chest pain.
f) Lesions in the skin, necrosis and clotting of the blood within the vascular system.
g) Headache, fever, running or blocked nose, pain, numbness and swelling in the face.
h) Difficulty in breathing, chest pain, fever and cough with blood appearing in the sputum at times.
i) Nausea, vomiting and stomach pain and bleeding.
Prognosis: This infection advances in a victim very fast and may be fatal up to 50% in sinus cases, 65%of the infected lung cases,15% of the skin infection type and the majority of the widespread type.
Diagnosis: This infection can be diagnosed by Culture and Biopsy. MRI is done to find out the extent of the disease.
Treatment: Once diagnosed, the infection is initially medically managed by administering antifungal medication, but some of the affected individuals may eventually need surgical intervention. During this treatment, it is essential to focus on controlling sugar levels, intake of steroids, and the discontinuation of immunosuppressants. The body should be adequately hydrated to administer the appropriate medicine. This treatment may last for 4 to 6 weeks.
Risk Factors: It has been observed that once the fungus starts germinating inside the body, it develops filaments invading the blood vessels forming clots and leading to the death of the surrounding tissue that has to be surgically removed.
Surgical Intervention: Surgery involves the total removal of all infected tissue in the nasal cavity, the brain, palate, eye structure and the upper jaw, which may call for more than one operation. Severely affected mucormycosis victims may at times tend to lose their eye and the upper jaw. When the patient’s condition stabilizes after the surgery, they may panic due to the sudden loss of certain facial body parts. Counselling and knowledge of prosthesis should be given before they lose their self-esteem and run into depression.
Causes: The causes for the sudden outbreak of this rare fungal infection of late has been presumed to link with many factors that include.
a) Negative pressure in hospital rooms leading to unclean air from outside to enter and contaminate the ailing patients.
b) Insufficient ventilation in the rooms.
c) Hospital bed sheets.
d) Any water leakages promoting the growth of this fungus.
e) Unclean or contaminated medical equipment used for the patients.
f) Any construction work in progress, generating dust inside the premises.
g) The line of treatment for covid patients in the recent epidemic.
a) Wear a mask compulsory in dirty and dusty places to avoid inhaling the fungus.
b) Avoid contact with any water leakage from buildings.
c) Avoid contact with manure, soil or any outdoor gardening activity.
d) Religiously wash hands and feet after coming in contact with any of the above activities.
Covid-19 and its association with Black Fungus: The recent Covid-19 pandemic in India has witnessed another epidemic, the sudden rise of Black Fungus cases. India has reported around 12000 cases which is 70 times more than the rest of the world. Some of the states have declared it an epidemic.
As this infection affects persons with reduced immunity due to various reasons cited above, the steep rise in the number of cases during the covid pandemic recently has raised the eyebrows of many.
Although there is no concrete medical evidence, the various causes presumed to be linked with the covid pandemic are as follows.
a) Use of steroids: Steroids play a vital role in the line of treatment for severely affected covid-19 patients with low saturation rates. It reduces the inflammation and stops the damage done to the lungs in a covid patient. But at the same time, it reduces immunity and elevates the blood glucose levels for diabetic and non-diabetic patients. This sudden fall in immunity could be one cause for the rise in Black fungal infection.
b) Continuous Oxygen support for severely affected covid patients leads to drying of the nasal cavity, increasing the risk of infection.
c) When a severely affected covid-19 patient having uncontrolled diabetes is administered steroids, the sugar level scales up, leading to acidic blood. The Black fungus thrives best in acidic environments with elevated blood glucose.
d) The shortage of oxygen in the country during the crucial hour forced the hospitals to procure the same from various sources, including oxygen tanks or cylinders. Some of these cylinders might have been outdated or the delivery systems may have been colonized by the fungus.
e) These emergencies were the result of the lack of preparation to manage the second wave of covid in India. The shortage of oxygen, the wrong propaganda about the effectiveness of the vaccine resulting in only a small population getting vaccinated.
f) Relaxation of restrictions during covid-19 and mass gatherings were also some factors that contributed to the sudden health emergency situation in India.