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Mucormycosis: An epidemic within a pandemic

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Umair Shafiq Khanday
COVID-19 has shaken the world ever since it surfaced. It has been mutating and throwing new challenges for not just the medical fraternity across the globe, but for the entire humanity.
Lately, multiple cases of a rare fungal infection called mucormycosis, inappropriately known as Black Fungus, have been reported in some of the COVID-recovering or recovered people.
What is Mucormycosis?
It is a serious but rare fungal infection, caused by a specific type of mold called mucor.
How does someone get it?
Mucor are environmental fungi that are present indoors and outdoors alike including soil, plants, decaying fruits and vegetables. These fungal spores are breathed in by humans on a daily basis, but are mostly harmless. However, immunocompromised people can develop an infection due to these inhaled spores.
Misinformation Alert: Pay Attention
Mucor is not black fungus. Black fungus belongs to a different category of fungi. This term got associated with mucormycosis due to the presence of black dots among the culture of white fungal colonies.
Mucor is not contagious. It does not spread from person to person like COVID-19 does.
Not spread by oxygenation, humidifier and water. There is no definite link between oxygen therapy and catching the infection. Many people taking treatment at home, who were not on oxygen therapy, have also been found to get infected with mucormycosis.
In the pre-COVID times, it was known to occur in people whose immune system doesn’t function well, such as uncontrolled diabetics, people taking immunosuppressive drugs after organ transplant, and cancer chemotherapy.
Some cases of this aggressive fungal infection had been observed during the 2003 SARS pandemic as well.
If it is rare, what’s causing the current surge?
A complex interplay of coronavirus infection, uncontrolled blood sugar levels, and immunosuppressive treatments have resulted in the surge of mucor infections in active, recovering / recovered COVID cases. Here’s how:
• COVID-19 causes a decrease in white blood cells that help your body fight infections, hence immunity is compromised.
COVID-19 cannot only worsen diabetes but also cause nondiabetics to develop it. High blood sugar levels provide a favourable growth environment for the fungi.[³]
• Misuse of certain drugs like steroids and tocilizumab during COVID-19 treatment can affect the immune status adversely
Don’t panic! Mucormycosis does not occur in all COVID cases.
90-95% cases of mucormycosis are found in people who are either diabetic and/or are taking steroids. [2] High-risk groups for COVID-associated mucormycosis include COVID-19 positive or recovered people with either or all of the following:
Uncontrolled diabetes
High-dose steroids therapy
• Immunomodulatory therapy like tocilizumab, baricitinib, etc.
Long stay in ICU
Please note: DON’T PANIC!
The risk and severity of this fungal infection depends largely on one’s immunity and overall health.
Early diagnosis is crucial: Watch for symptoms
COVID-associated mucormycosis generally starts in the nose and may progress to the eye and brain.
Early disease: Nose and sinus involvement
• Blocked nose or nasal discharge
• Sinus pain or headache (persistent or severe that does not respond to pain medicines)
• Facial pain, numbness or swelling
• Bluish-black discoloration of facial skin
• Loosening of teeth, discoloration or ulceration of palate
Moderately advanced disease: Eye involvement
• Pain, swelling or redness in eyes
• Drooping eyelid
• Double vision
• Loss of vision
If you are recovering or have recovered from COVID-19 and noticing any of the above symptoms, consult a doctor IMMEDIATELY. Early diagnosis and treatment can reduce complications.
Tests for Mucormycosis
. Your doctor will identify this fungal infection based on your medical history and thorough clinical evaluation
• If needed, a swab from nose is taken and tested for fungus
• Other specialized tests, including biopsy and CT scan might also be required in some people
Is mucormycosis treatable?
The condition is treated with antifungal medicines including Liposomal Amphotericin B, Posaconazole, and Isavuconazole. Surgery can also be needed. It is important to note that the prognosis is largely dependent on rapid diagnosis and early management
What can you do to keep yourself safe?
Never ever self-medicate, especially steroids
Track and control blood sugar levels post discharge and in diabetics
Watch for symptoms and do not lose any time in starting treatment
Follow your doctor’s instructions on seeking advanced investigations whether biopsy or CT
Maintain basic hygiene and cleanliness
Word of Advice
Mucormycosis is a rapidly progressing, life-threatening infection, with high mortality rates ranging from 40 to 80% 4) Do not ignore symptoms, trust your doctor and seek early treatment
Know fungal infection by name, not by color
A few cases of white fungus and yellow fungus have also been reported lately. The scientific names of these fungi are Candidiasis and Aspergillosis, respectively.
What is observed in COVID-19 is mostly mucormycosis; aspergillosis is observed occasionally, and Candida in some people..
(The author is pursuing a course in Nursing in Rajasthan)

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