Facts to know about Mucormycosis
Dr. Purva Joshi
Mucormycosis is a rare but serious fungal infection caused most commonly by ‘Mucor’ and ‘Rhizopus’ species of fungi including few others. It is also known as ‘Black Fungus‘ whose incidence is increasing since the past few weeks and is a major concern specifically in post covid recovered individuals.
This fungal infection is an opportunistic infection, which takes a toll when there is a weakened immune system in people due to several reasons. The high risk groups include-
1) Patients with uncontrolled diabetes
2) Patients having any sort of cancer and undergoing therapy that involves immunomodulation
3) Patients using steroids for long term
4) Individuals having an organ transplant which involves use of immunosuppressants
5) Persons with a history of having tuberculosis in the past or active infection
The increasing incidence in post Covid cases can be attributed to following-
1) Prior existence of comorbidities like Diabetes, where the immune system is already jeopardized, injudicious use of steroids to reduce inflammation of tissues after contracting covid-19 that altogether creates a fragile immune status.
2) Prolonged ICU stay, repeated intubations to combat respiratory crisis.
3) Prolonged hospitalization with increased risk of hospital acquired infection, exposure to infected linen, wet areas, cross contamination with negative pressure rooms .
Mucormycosis can typically affect the brain, oral cavity, eyes, lungs, skin, gastrointestinal tract, spleen, kidneys and other organs of the body.
It may be caused due to inhalation, inoculation or ingestion of fungal spores.
The spores are more commonly found in environments with wet zones like soil, flooded water, accumulated water, and less commonly in air. If the spores are inhaled from the atmosphere it may affect the nose, oral cavity, eyes, and may reach out to the brain via sinuses. This is called ‘Rhinocerebral mucormycosis‘.
The typical alarming signs in such cases are-
1) Nasal congestion, loose teeth, toothache, one sided facial pain, swelling, numbness on face, blurred vision, drooping eyelids, loss of vision, headache, fever and in some cases black discolouration around the skin of the nose bridge.
2) If the spores are inhaled into the lungs, it causes ‘Pulmonary Mucormycosis‘ with typical signs of cough, chest pain, difficulty in breathing. The spores may be inoculated in the skin through cuts, open wounds, burns, and cause Cutaneous Mucormycosis with alarming signs of blisters, ulcers, red inflamed areas, cellulitis and gradually turning to black eschar formed due to necrosis of tissue (by which the name black fungus) that requires immediate removal. In rare cases, the fungal spores may be ingested and can cause Intestinal Mucormycosis with alarming signs of nausea, vomiting, gastric bleed.
3) There have been cases reported where the infection has affected the kidneys and spleen also.
The disease can be diagnosed through tissue biopsy and culture . The treatment involves antifungal therapy, which includes medicines like Amphotericin B, Posaconazole and Naviconazole. But ironically, the stocks are not sufficient to suffice the sudden increasing demand of these medications in the current scenario. In such cases it becomes very important to know how to prevent the disease from occuring. Although not much literature is available till now, the advisory guidelines released by the officials say that we can prevent the disease by following means-
1) Wearing mask, and avoiding contact with dust, mites, allergens
2) Wearing shoes, long trousers, full sleeve shirts and gloves while handling soil, taking due precautions while handling manure, compost
3) Maintaining proper hygiene including thorough scrub therapy
4) Having balanced, nutritious diet and keeping a good immune system
Although the disease is not contagious, it may not spread from one infected person to another, but it is very important to take due care about the signs, symptoms, early diagnosis and treatment and more importantly about preventing the disease .
Dr. Purva Joshi is a Public Health Specialist and Drug Safety Physician at IQVIA, Thane