Mucormycosis or black fungus has become a topic of major concern during the COVID-19 pandemic in India. To tackle this problem, it is important to understand what causes Mucormycosis, Black Fungus Symptoms and how to prevent the same.
What is Mucormycosis?
Mucormycosis or black fungus is an opportunistic infection caused by a group of funguses called mucormycetes.
Mucormycetes are ubiquitous in our environment and thrive in damp, warm areas having low sunlight and cross ventilation such as hospital ICUs.
Mucormycosis affects patients having low immunity such as those having uncontrolled diabetes, those patients who are undergoing cancer treatment, having liver or kidney failure, and those having conditions like HIV.
Why is it dangerous?
Rhinocerebral mucormycosis causes blood vessel clotting and death or necrosis of tissue supplied by that blood vessel. It paralyzes the nerves it travels through.
Mucormycosis starts in the nose and sinuses and rapidly spreads to the eyes causing loss of vision and then spreads to the brain within a matter of few days
Once the infection reaches the brain, chances of survival reduce exponentially.
Why are the Mucormycosis cases increasing during this COVID pandemic?
Mucormycetes preys on patients having lower immunity.
Adding to this, one more condition which can add fuel to the fire is increased iron levels in the blood, an essential element for mucormycetes growth.
Covid causes both of these – it lowers the immunity levels and also increases the iron levels in the blood because of COVIDs tendency to cause clot formation causing the breakdown of RBCs and releasing iron
Steroids such as dexamethasone, prednisolone, and methylprednisolone are very commonly used for the treatment of COVID.
Steroid usage is a double-edged sword, although it helps in recovery from COVID, it causes further fall in immunity levels reducing the body’s ability to fight mucormycetes.
Steroids usage also causes an increase in blood sugar levels
In Diabetic patients, who are already low on immunity owing to diabetes, steroids usage pushes blood sugar levels to alarmingly high levels causing what is known as diabetic ketoacidosis.
In diabetic ketoacidosis, iron levels in the blood rise.
So in COVID patients having diabetes, a lethal cocktail of doubly lower immunity levels and doubly high blood iron levels cause mucormycosis to flourish.
Black fungus symptoms - What are the early signs to look out for?
Early diagnosis and treatment of Mucormycosis is very crucial for the survival of the patient. The early black fungus symptoms are –
- Blackening of skin on and around the nose, eyes, the upper part of the mouth
- Swelling of nose, eyes, cheeks
- Blackish or bloody nasal discharge
- Nose block
- Loss of touch sensation over nose, cheek
- Deterioration of vision
How to prevent it?
After COVID-19 infection recovery, it is not the end of the story.
1. Diabetics must be very vigilant, they must get their blood sugar tests done regularly and make sure their sugar levels are under good control. If sugar levels are not under control, an immediate visit to physician/endocrinologist is necessary and necessary medication changes must be made.
2. But what about patients who have diabetes but are not aware of it. A recent cross-sectional study from all states of India revealed that 47% of Indians are unaware of their diabetic status. All patients diagnosed with COVID 19 must get HbA1c blood test done. HbA1c is a measure of how well controlled your blood sugar has been over a period of about 3 months. if HbA1c is above 8%, anti-diabetic treatment must be initiated
3. Patients must be aware of early black fungus symptoms and signs of mucormycosis. If any suspicion arises, visit a nearby ENT doctor. He will thoroughly examine you, advise CT scan of nose and sinus, and nasal endoscopy if necessary.
4. If there is suspicion that you may contract mucormycosis, your ENT doctor and physician can start you on nasal saline rinses and inhalational liposomal amphotericin.
5. If Oxygen support is given at home away from nursing supervision, Make sure distilled water is used in a humidifier attached to the oxygen supply. Make sure there is no leakage from the humidifier. The water in the humidifier must be changed regularly.
6. Avoid self-medication with steroids, immunosuppressant drugs like tocilizumab without doctor consultation, prescription, and supervision.
7. Stay away from damp, badly ventilated rooms. Prefer rooms having good cross ventilation.
8. Maintain good hand hygiene and strictly avoid Nose picking.
9. Immunity boosting foods must be consumed.