Mucormycosis: A fungal infection, we must aware of mucormycosis symptoms: treatment: prevention and risk factor.
In India with the second wave of the COVID-19 pandemic, new fungal infection cases have been registered, which can be as deadly as the Coronavirus. Till now, four types of fungal cases have been reported in the country i.e., black, white, yellow and Aspergillosis. The central government has asked all the states to declare black fungus as an epidemic. Many states have declared black fungus as an epidemic disease including Madhya Pradesh, Rajasthan, Uttarakhand, Tamil Nadu and Bihar under the Epidemic Act 1897.
Status of Mucormycosis in India:
According to the latest government data on 25th May, the country has recorded 11,717 cases of "Black Fungus" or Mucormycosis so far with Gujarat, Maharashtra, Andhra Pradesh, Madhya Pradesh and Telangana logging the highest number of rare fungal infections. While Maharashtra has reported 2,770 cases, Gujarat has logged 2,859 cases, Andhra Pradesh has registered 768 cases, Madhya Pradesh has 752 cases, and Telangana has 744 cases so far.
What is Mucormycosis?
Mucormycosis (previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds live throughout the environment. Mucormycosis mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. It can also occur on the skin after a cut, burn, or other type of skin injury. It can be life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS.
Mucormycosis in Covid19 Patients:
The mucormycosis, colloquially as “black fungus”, is being detected relatively frequently among Covid-19 patients in some states. According to doctors, COVID-19 patients, diabetics and people on long use of steroids are more at risk of getting infected with black fungus. Some experts claim the prolonged ICU stay can also increase the risk of black fungus.
Doctors believe mucormycosis, which has an overall mortality rate of 50%, may be being triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients. Steroids reduce inflammation in the lungs for Covid-19 and appear to prevent some of the damage that can happen when the body's immune system goes into overdrive to fight off Coronavirus.
But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients. It's thought that, this drop in immunity could be triggering these cases of mucormycosis.
1) Uncontrolled diabetes
2) Weakening of immune system due to use of steroids
3) Prolonged ICU/hospital stay
4) Comorbidities / post organ transplant / cancer
5) Voriconazole therapy (used to treat serious fungal infections)
Symptoms of Mucormycosis:
"Presentation of two types of mucormycosis has been commonly observed with Covid-19 patients, whether active, recovering or post-discharge. This includes Rhino-Orbito-Cerebral Mucormycosis (ROCM) and Pulmonary mucormycosis," said Dr Minal Vohra, Consultant Endocrinologist, BeatO.
1.Rhino-Orbito-Cerebral Mucormycosis (ROCM):
In simple words, ROCM means the mucormycosis in which the fungus affects the nose, eyes and brain. This disease originates from the nose and rapidly spreads along the sinus passage to infect the orbit (bone cavity which surrounds the eye) and brain.
Symptoms of Rhinocerebral (Sinus and brain) Mucormycosis include:
One-sided facial swelling
Headache
Nasal or sinus congestion
Black lesions on nasal bridge or upper inside of mouth that quickly become more severe
Fever
Pulmonary Mucormycosis:
Pulmonary mucormycosis is common among immunocompromised patients whose immune systems have lowered ability to fight infections and diseases.
Symptoms of Pulmonary (lung) Mucormycosis include:
Fever
Cough
Chest pain
Shortness of breath
Note: After recovering from Coronavirus, one should closely monitor and should not miss any warning signs and symptoms mentioned above, as the fungal infection is found to emerge even weeks or months after recovery.
Things Must To Check in Covid19 Patients:
Control Hyperglycemia
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/antifungal judiciously
Never Ignore in Covid19 Patients:
Do not miss warning signs and symptoms
Do not consider all the cases with 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 & microscopy, culture, MALDI TOF), for detecting fungal etiology.
Do not lose crucial time to initiate treatment for mucormycosis.
Except Covid Patient Who all other at Risk:
Mucormycosis is rare, but it’s more common among people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. Certain groups of people are more likely to get mucormycosis, including people with:
Diabetes, especially with diabetic ketoacidosis
Cancer
Organ transplant
Stem cell transplant
Neutropenia pdf icon[PDF – 2 pages] (low number of white blood cells)
Long-term corticosteroid use
Injection drug use
Too much iron in the body (iron overload or hemochromatosis)
Skin injury due to surgery, burns, or wounds
Prematurity and low birthweight (for neonatal gastrointestinal mucormycosis).
Some important questions and answers:
1. Can you get black fungus infection without testing positive for COVID-19?
Ans: Yes
Note: The highest risk of catching fungal infections of any kind right now exists for those people who have a history of high blood sugar levels or uncontrolled diabetes. If they do not test SARS-CoV-2 positive, they may develop a rare fungal infection if their blood sugar is particularly high. The risk of developing the infection rises if the patient is suffering from significant other diseases along with uncontrolled diabetes.
A diabetic patient becomes more susceptible to black fungal infection if their blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL). This is a serious diabetes complication where the body produces excess blood acids (ketones). Medically this situation is known as diabetic ketoacidosis.
2. Is Black Fungus Contagious?
Black fungus is not contagious and cannot spread from one person to another. AIIMS director Dr Randeep Guleria confirmed the news. He stated, “It is not contagious. Low immunity leads to Black Fungus. As per American Center of Disease Control & Prevention (CDC), No. Mucormycosis can’t spread between people or between people and animals.
3. Why mucormycosis is called Black fungus in India?
The mucormycosis after establishing itself in the nose and sinus, it begin to invade the tissue of the face, the jaw, the eyes and the brain, blocking blood flow and causing tissue death. It is the black discoloration of dead tissue that conferred upon the mould as “black fungus” in India.
4. What is the treatment for Mucormycosis?
Mucormycosis needs to be treated with prescription antifungal medicine. In some cases, it can require surgery; it can lead to eventual loss of the upper jaw and sometimes even an eye.
5. How to Prevent Mucormycosis?
Protect yourself from the environment. It’s important to note that although these actions are recommended, they haven’t been proven to prevent mucormycosis.
Ø Try to avoid areas with a lot of dust like construction or excavation sites. If you can’t avoid these areas, wear an N95 respirator (a type of face mask) while you’re there. Click here for more information about respirators.
Ø Avoid direct contact with water-damaged buildings and flood water after hurricanes and natural disasters.
Ø Avoid activities that involve close contact to soil or dust, such as yard work or gardening. If this isn’t possible,
Wear shoes, long pants, and a long-sleeved shirt when doing outdoor activities such as gardening, yard work, or visiting wooded areas.
Wear gloves when handling materials such as soil, moss, or manure.
To reduce the chances of developing a skin infection, clean skin injuries well with soap and water, especially if they have been exposed to soil or dust.
Awareness is much more necessary in mucormycosis. So that people will be attentive to the rare fungal infection and take advice from doctors if they catch the infection and save their lives. Union Health Minister Harsh Vardhan said, "Awareness and early diagnosis can help curb the spread of the fungal infection."
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