31 May, 2021

Mucormycosis in relation to COVID-19

What is Mucormycosis?

• Mucormycosis, widely known as ‘Black fungus’, is an aggressive and rare but deadly fungal infection.
• It usually affects the vital organs such as the eyes brain and lungs, also the sinuses (due to its rich blood supply).
• Mucormycosis usually occurs in people with weakened immune system (immune-compromised) in certain conditions/diseases.

Mucormycosis symptoms are usually based on the organ system it has affected; it basically shows five presentations:

• Rhino-cerebral (Affecting sinuses & brain)
• Pulmonary (Involving lungs)
• Cutaneous (Involving skin)
• Gastrointestinal
• Disseminated (widespread, in immuno-compromised people)

What are the symptoms of mucormycosis affecting the sinus or brain or rhino-cerebral symptoms of mucormycosis?

• Nasal or sinus congestion and/or discharge
• Sinus pain
• Skin changes above sinuses; redness, bluish discoloration, black lesions on nasal bridge due to lack of oxygen
• Severe headache (when brain is involved)
• Swelled or protruded eyes
• Double vision or loss of vision
• Facial swelling (sometimes)

What are the symptoms of mucormycosis affecting the lungs or pulmonary symptoms of mucormycosis?

• Fever
• Non-productive cough (with no mucous)
• Chest pain
• Breathlessness or difficulty breathing (dyspnea)

What are the symptoms of mucormycosis affecting the gastrointestinal (GI) tract or gastrointestinal symptoms of mucormycosis?

• Severe abdominal pain (due to lack of blood flow)
• Nausea
• Vomiting; sometimes blood in vomiting (hematemesis)
• Blood in the stools
• Bleeding from the GI tract
• Lesions developing in the GI tract causing formation of a hole or perforation

Who is at Risk of Contracting Mucormycosis?

People with low or weakened immunity are at high risk of contracting this fungal infection such as:

• Diabetic patients (especially uncontrolled or with diabetic ketoacidosis)
• Patients on prolonged steroid therapy
• Patients on immunosuppressive therapy:
  • Blood cancer patients (leukemia, lymphoma)
  • Patients received any solid organ transplants
  • Hematopoietic stem cell transplants
• Neutropenic patients i.e., patients with low neutrophils (a type of white blood cell) count

What are the reasons Mucormycosis is affecting people suffering from COVID?

Coronavirus disease or COVID infections may be associated with a wide range of bacterial and fungal co-infections and in the recent days we’ve had been seeing a sudden increase in the Mucormycosis infection in the COVID patients.

• The doctors are considering the prevalent and uncontrolled use of high doses of steroids administered with an intention to counter the body’s immune response against COVID.
• The steroids are responsible for an increase in the blood sugar levels irrespective of the person being diabetic or non-diabetic.
• And these raised blood sugar levels act as a favorable medium for the growth and responsible for its invasive nature resulting into a severe disease.

This is the main reason behind an increase in the mucormycosis cases amongst COVID patients.

What are the steps to keep yourself safe from mucormycosis?

Early detection of symptoms & timely consultation with the doctor always improves the chances of better recovery.

• Controlling hyperglycemia & regular monitoring of blood glucose level both in diabetics and after recovering from COVID
• Improving personal & oral hygiene
• Continue wearing mask
• Better public & domestic sanitation
• Avoid damp places & clothes
• Correct and judicial use of steroids
• Avoid inadvertent use of antibiotics/antifungals

How is Mucormycosis diagnosed?

In case of any of the symptoms, it is always advised to consult an ENT surgeon at the earliest.

Diagnostic tests include:

• Nasal endoscopy – It detects any invasion of nasal lining as red or black discoloration of nasal mucosa.
• Biopsy – It is done to confirm the fungus when nasal mucosal invasion is detected in nasal endoscopy.
• Imaging tests – CT scan or MRI detect how much the fungus has spread and invaded within the body.

How can be Mucormycosis treated?

The treatment of Mucormycosis or Black fungus includes:

• Surgical treatment – Performed straight away to ensure removal of dead and infected tissue.
• Medical treatment – Use of specific medications against the fungus (antifungal agents) which inhibits fungal growth and prevents its spread. Usually given for about 4-6 weeks depending on the clinical condition.

References:

https://rarediseases.org/rare-diseases/mucormycosis/
https://www.cdc.gov/fungal/diseases/mucormycosis/symptoms.html
https://medlineplus.gov/ency/article/000649.htm
https://www.cdc.gov/fungal/diseases/mucormycosis/risk-prevention.html

Author: (Dr Sashikanth Jonnalagadda)