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What is black fungus / Mucormycosis?

Black Fungus What is it?
Mucormycosis is a serious fungal infection caused by molds called mucormycetes.  People get mucormycosis particularly in those who have health problems or take medicines like steroids that lower the body’s ability to fight germs.

Types of mucormycosis

  1. Rhinocerebral mucormycosis is an infection in the nose and sinuses that can spread to the brain. This form of mucormycosis is most common in people with uncontrolled diabetes and in those who took steroids for COVID-19 infection.
  2. Pulmonary mucormycosis is the most common type of mucormycosis in people with cancers.
  3. Gastrointestinal mucormycosis is more common among young children than adults, who have had antibiotics, surgery, or medications that lower the body’s ability to fight germs and sickness. 9-10
  4. Cutaneous (skin) mucormycosis: occurs after the fungi enter the body through a break in the skin, after surgery, a burn, even in those who do not have weakened immune systems.
  5. Disseminated mucormycosis occurs when the infection spreads through the bloodstream to other parts of the body. 

Symptoms of Mucormycosis

The symptoms of mucormycosis depend on where in the body the fungus is growing. 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 (lung) mucormycosis include:

  • Fever
  • Cough
  • Chest pain
  • Shortness of breath

Skin mucormycosis can look like blisters or ulcers, and the infected area may turn black. 

Gastrointestinal mucormycosis include:

  • Abdominal pain
  • Nausea and vomiting
  • Gastrointestinal bleeding

Disseminated mucormycosis is seen in those who are already sick from other medical conditions and can be difficult to know which symptoms are related to mucormycosis. 

Who gets mucormycosis?

Certain groups of people are more likely to get mucormycosis like

  • Diabetes, especially with uncontrolled or on those with steroids use
  • Corticosteroid use 
  • Cancer
  • Organ transplant
  • Excess iron in the body (iron overload or raised ferritin as seen in COVID-19)

How does someone get mucormycosis?

The lung or sinus forms of the infection can occur after someone inhales the spores from the air. In COVID-19 pandemic, this is seen probably due to multiple factors including possibly the spores in the tubings for oxygen.

Is mucormycosis contagious?

No. Mucormycosis can’t spread between people .

How can I lower the risk of mucormycosis?

For people who have weakened immune systems like those recovering from COVID-19, taken steroids, used oxygen therapy etc, there may be some ways to lower the chances of developing mucormycosis.

  • Try to change masks and reduce reusing the same mask frequently.
  • Wear an N95 face mask.
  • Try to avoid areas with a lot of dust like construction or excavation sites. 
  • Limit steroid use only on doctor’s advice for severe COVID-19.
  • Keep diabetes under control. 

How is mucormycosis diagnosed?

When we suspect mucormycosis in the lungs or sinuses fluid sample from nose, throat, tissue biopsy of affected tissue is analyzed in a laboratory for evidence of mucormycosis under a microscope or in a fungal culture. CT scan of the lungs, sinuses, or other parts of your body may be required.

How is mucormycosis treated?

Mucormycosis is a serious infection and needs to be treated with amphotericin B, posaconazole, or isavuconazole. Other medicines like fluconazole do not work against fungi that cause mucormycosis. Often, mucormycosis requires surgery to cut away the infected tissue.

How to avoid mucormycosis during this COVID-19 pandemic?

Mucormycosis is a serious infection and the best way is to avoid getting it. The best measures at present are

  • Keep diabetes under control.
  • Take steroids for COVID-19 only when severe and oxygen levels dropping as per your doctor advise.
  • Keep glucose levels under control if on steroids.
  • Avoid masks that have been used earlier.
  • Ensure the oxygen supply tubes are clean and sterile. Eg. Oxygen concentrators.