BLACK FUNGUS (MUCORMYCOSIS)

CONTEXT:

The Union government has asked the States to declare mucormycosis, the fungal infection being reported in COVID-19 patients, an epidemic. In a letter to the States, Health and Family Welfare Ministry said declaring the black fungus infection seen in COVID-19 patients an epidemic would lead to health facilities screening for it and reporting all such cases to the government.

What is Mucormycosis?

• Mucormycosis is an aggressive and invasive fungal infection caused by a group of moulds called micromycetes.
• It can affect various organs but is currently manifesting as invasive rhino-orbito-cerebral disease, crawling through the sinus and working its way to the brain, affecting the ear, nose, throat, and mouth.
• While it is not contagious, it can cause a lot of damage internally and can be fatal if not detected early.
• It is an old disease; perhaps new and concerning is the sudden increase in the invasive form of the sinus variant, which involves the orbit, and at times the brain, leading to blindness, stroke or death.

What causes the disease?

• Diabetes mellitusis the most common underlying cause, followed by haematological malignancies and solid-organ transplants. Diabetes mellitus was reported in 54% to 76% of cases, according to a report.
• What seems to be triggering mucormycosis in patient’s post COVID-19 is indiscriminate use of a high dose of steroids in COVID-19 patients, sometimes even in minimally symptomatic patients. This leads to spikes in the sugar level among diabetics, which, in turn, renders them vulnerable.
• Rational use of steroids is necessary, and constant monitoring of sugar levels and resorting to insulin use to control these levels if required, is essential.
• The use of monoclonal agents like Tocilizumab may be a factor, too.
• Experts also opine that while the fungi are present in the environment, the use of nasal prongs and other devices for oxygen delivery and possible breach of sterile conditionscan possibly lead to cross-infection and hospital-acquired infection.

Symptoms

• The symptoms to watch out for are a stuffy nose, bloody, blackish, or brown discharge from the nose etc.
• Other symptoms include blackish discolouration of the skin, swelling or numbness around the cheek, one-sided facial pain, toothache or jaw pain, drooping of the eyelids or eyelid swelling, double vision, redness of eyes, and sudden decrease in vision.

Treatment

• The mainline of treatment is an anti-fungal drug called amphotericin B, which is given over an extended period of time under the strict observation of a physician.
• Rational use of steroids is necessary and constant monitoring of sugar levels and resorting to insulin use to control these levels if required is essential.
• Surgery to remove the fungus growth might also be warranted.

Preventive measures

• It is important to keep blood sugar levels under control and ensure that appropriate calibration of oral drugs or insulin is done from time to time.
• Further, recognising the symptoms and seeking treatment early if there are two or three symptoms at a time is key.
• Like most illnesses, if detected early, Mucormycosis can be cured.