Black fungus in COVID-19 Patients

1) What is Black Fungus?

Black fungus (Mucormycosis) is very rare infection, caused by exposure to mucor mould which is commonly found in soil, plants, manure, decaying fruits and vegetables and even in the nose and mucus of healthy people.

 2) Organs involved?

It affects the para-nasal sinuses, brain, lungs, skin, GIT.

3) Black fungus in COVID-19 patients?

Black fungus may be triggered by the use of steroids in severe and critically ill COVID-19  positive patients.

Steroids reduce inflammation in the lungs & in whole body and appear to help stop some of the damage that can happen when the body's immune system goes into overdrive to fight off COVID-19. 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 Black fungus (mucormycosis) in COVID-19 Positive patients.

4) Risk factors?

Immunocompromising conditions are the main risk factor for mucormycosis. Patients with uncontrolled diabetes mellitus, cancer, Kidney transplant recipients, Severe malnutrition, neutropenic patients and individuals receiving immunosuppressive agents, including oral or intravenous steroids and tumor necrosis factor TNF-alpha blockers are the main risk factors.

5) Mode of transmission?

Inhalation (major route):- When spores are deposited in the nasal turbinates, rhinocerebral disease develops, when spores are inhaled into the lungs, pulmonary disease develops.

Ingestion:- causes GI disease.

Cutaneous:- when the agents are introduced through interrupted skin, cutaneous disease develops.

6) Symptoms?

Stuffy nose, brown nasal discharge, tooth ache, loose teeth, facial pain and swelling, double or blurred vision, fever, shortness of breath, cough,  headache, redness/pain/swelling of eye, altered sensorium, bloody vomitus.

7) Dos and Don'ts in COVID-19 positive patients.

Dos

Control hyperglycaemia

• Monitor blood glucose level post COVID-19 discharge in diabetic patients

• Use steroid judiciously

• Use clean, sterile water for humidifiers during oxygen therapy

• Use antibiotics/antifungal judiciously

Don'ts

. Do not miss warning signs & symptoms

• Don't consider all cases of blocked nose as cases of bacterial sinusitis, especially in the cases of immuno-suppression and or COVID-19 patients on immuno-modulators

• Don't hesitate in seeking aggressive investigations as appropriate for detecting fungal etiology.

8) Prognosis?

It has an overall mortality rate of 50%-85% (100% in disseminated disease)

©Dr. Mohammad Abas Reshi