Mucormycosis amid COVID-19: Understanding the ‘Black Fungus’ disease

About Author: Dr Manusrut is the Consultant for Ear Nose Throat (ENT) Head and Neck surgeon at Yashoda Hospitals, Hyderabad. He is an expert with advanced training in Cochlear Implantation and Ear surgery. One of the first and youngest Fellowship-trained Cochlear Implant Surgeons in India, he has experience of performing more than 1500 surgeries encompassing all subspecialties of Ear, Nose, Throat, and Head and neck diseases.

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An Increased surge of Mucormycosis disease also known as ‘Black Fungus’ has been found in patients with COVID-19. The disease starts from the nose and sinus, then quickly spreads to the eyes and the brain. On an average, 50 percent of patients may not even survive despite being provided with the best treatment possible, if the fungus spreads to the brain, and then there is hardly any chance for the patient to survive. It used to be a rare disease, doctors attended to hardly one case a year, but now the circumstances have changed and ENT specialists are seeing an increased incidence of mucormycosis in patients with active COVID-19 or who have recovered from it. Most of the patients with Mucormycosis are diabetics and have a history of taking steroids for Covid treatment that raises their sugar levels.

Early signs and symptoms

The early signs and symptoms for Mucormycosis disease are like this:

• One-sided severe headache and pain behind the eye.

• Nasal stuffiness, discharge or occasional bleeding.

• Eyes swelling, inability to open eyes, redness of eyes, double vision, loss of vision etc.

• Ulceration or Blackish discolouration of the roof of the mouth (palate).

• The disease quickly progresses to the brain causing drowsiness, facial paralysis, numbness of the face,  stroke, one side paralysis and even death.

COVID-19 positive patients of all ages are at high risk, especially the patients with a history of prolonged steroid usages, Diabetics, on immunosuppressants etc.

Origin of Mucormycosis

Mucormycosis, the group of parasites that cause mucormycosis, are available all through the climate, especially in soil and in contact with rotting natural bodies, like leaves, fertilizer heaps, and creature waste. They are more normal in soil than in air, and in summer and fall than in winter or spring. Most individuals interact with minute parasitic spores consistently, so it’s presumably difficult to try not to interact with mucormycosis. These parasites aren’t harmful to many people. In any case, for individuals who have weakened immunity, taking in mucormycosis spores can cause disease in the lungs or sinuses which can spread to different pieces of the body.

Treatment procedure for Mucormycosis

The key to this treatment is to have a high index of suspicion and timely intervention. Immediate surgery is required to remove the affected dead tissue and bone from the nose, and some patients require the removal of their eyes also.  After that, the patient needs an Antifungal injection, Amphotericin B which has to be taken for 4- 6 weeks to avoid any further spread of disease.

The injection is reported to be in short supply due to the increase in cases all over the country.

Most of the patients had a medical history of diabetes and were treated with steroids.  Few patients underwent surgery while having active COVID-19 disease as any delay is harmful. Three of the patient’s eyes also had to be removed as it had become a focus of fungal infection.

This disease has now reached epidemic proportions, as cases are being reported from Gujarat, Maharashtra, Telangana, Andhra Pradesh also.

Mucormycosis can only be checked by controlling sugar level in diabetic patients, especially patients who are on steroids.  If someone is taking steroids then it should be regulated properly. To avoid any fungus settling in the nose these patients should start washing their nose with normal saline mixed with betadine.