Black fungus, a detailed discussion

The black fungus also known as mucormycosis is a dangerous and opportunistic infection caused by common fungi belonging to the Mucorales group. It can be caused due to direct contact with fungal spores from the environment. It can also be in the skin where the fungus enters through a cut, scrape or wound. Fungal thrives in environments like decaying organic matter, soil, compost piles, rotten food et cetera. This is a rare fungal infection with a high mortality rate that is 54%. it happens only to those who have health issues or who take drugs that compromise the immune system.

There are many infections in the form of fungus or bacteria is that thrive in natural environment but do not infect us because of a strong immune system. The good thing about black fungus is that it is not contagious, it means it cannot spread from contact between human or animal. When a person is chronically ill or on drugs that suppress the immune system, he is at a greater risk of infection. Apart from black fungus cases, white fungus and yellow fungus which is a deadlier form have been reported.

Medical experts have said that all these fungal infections are mucormycosis only, but the colour of discharge separates them. For example, if a person has infection onnface, eyes, brain and lungs which causes black colouration of tissues it’s called a black fungus. When the fungus attacks private parts, white colour discharge is recorded hence the name white fungus. The fungus also causes wounds that have pus formation which gives yellow coloured discharge, slows healing of wounds and extreme fatigue hence yellow fungus. Yellow fungus is denser and may cause devastating indications like acute necrosis hence takes more time to heal.

Black fungus can easily enter via nose, mouth and eyes, they can affect working of brain if not attended in a timely. According to medical experts misuse of steroids to treat COVID-19 is the primary cause of black fungus infection. Steroids increase persistence, muscle and bone vitality, production of red blood cells. Remedesivir is mostly administered to patients who have severe lung infection score on CT scans due to Covid 19. Immunity is low after COVID-19 treatment which makes patients susceptible and people with diabetes are at an increased risk to black fungus infection. Maharashtra, Gujarat, Andhra Pradesh, Madhya Pradesh and Telangana have recorded 65% of India’s black fungus cases. 11 state government have confirmed it as an epidemic.

What are the Symptoms of black fungus?

Symptoms of black fungus are different according to the body part infected. If the infection grows in the sinuses and brain symptoms include fever, one-sided facial swelling, headache and nasal or sinus congestion. If the fungi have affected lungs the symptoms encompass cough, chest pain and shortness of breath. If black fungus has affected the digestive system symptoms comprise of abdominal pain, nausea, vomiting and gastrointestinal bleeding. Symptoms may include black lesions on nose or inside the mouth, blood in stool and diarrhoea. Skin may appear red, swollen, tender or blistered. Blood can transfer this infection to other parts of the body hence quick action is mandated, else heart and spleen are compromised. Cases have been reported where patients needed to undergo surgery to remove either an eye to cure themselves of black fungus.

Who are at risk from black fungus?

People who fall into certain categories are at an increased risk of infection to black fungus.

People who have uncontrolled diabetes, diabetic ketoacidosis and diabetics who take steroids for medicinal purposes or tocilizumab.

Patients who take immunosuppressants, who are receiving anticancer treatments and those who are suffering from chronic illness are at a greater risk of infection.

Patients taking high doses of steroids for an extended period of time like bodybuilders, actors, sportspersons etc. Patients who have just recovered from severe COVID-19 infection, patients who require breathing aid like nasal prongs, masks and ventilators.

Due to the sudden jump in demand for oxygen, caution wasn’t exercised while making oxygen concentrators, humidifiers or saline solutions which also caused black fungus outrage.

What are treatments of black fungus?

Treatment of black fungus needs to be fast and precise. Major concern that sprung up during Covid 19 is the delay in diagnosis and treatment. By the time the patient is given medicine, tissues have been damaged permanently and significantly. A sudden increase in black fungus cases lead to scarcity of its medicines which was also a reason why people died. Since black fungus is a rare disease, medicines that cure it are not stocked. Whatever may be the exact cause of the infection, fungus attacks body only when personal hygiene, cleanliness is compromised and contaminated food is ingested.

Patients are advised surgical procedures by the surgeons where infected tissues are removed. Antifungal drugs are administered to a patient to stop the spread of fungus and to treat the debilitating disease. Amphoterecin B is preferred drug for treatment. Other than that Posaconazole or Isavuconazole are also prescribed to treat black fungus. Antifungal procedure lasts up to 6 weeks were diabetes or blood sugar level of the patient has to be kept in check. Patients who are on steroids have to stop them immediately. This is the Catch-22 where steroids are required to treat COVID-19, but steroids have to be stopped to cure black fungus.

How can one prevent black fungus?

Simple precautions if followed religiously can avoid infection of black fungus. Patients who are using oxygen concentrators or humidifiers have to make sure that they are clean. The humidifier bottle should be cleaned with a saline solution and refilled regularly. Masks should be disinfected and cleaned regularly and discarded after some time.

Patients who are on steroids need to keep their blood sugar levels in check. For COVID-19 treatment modified oxygen should be used to avoid aerosol dispersion in the surrounding. Practising clean hygiene is always advisable. To take care of one’s throat brushing and gargling is prescribed, post-Covid recovery mandates use of mask.  Immunosuppressants should be immediately discontinued and diabetics should monitor their blood sugar level regularly.

Why diabetes pose an increased risk of infection?

To avoid Black fungus infection blood sugar levels post-Covid have to be kept in check and regularly monitored. A combination of healthy habits like exercise, diet, stress management, medicines and weight management can avert the risk of infection.

Do not take steroid therapy without doctors consultation because it messes up blood sugar control. Cases that have mild to moderate infection do not require steroid, steroid is only prescribed oxygen saturation goes down.

To avoid interaction with fungus maintain good personal hygiene and cleanliness because this fungus is found on decaying organic matter. If immune system is suppressed measures like keeping a clean and dry mask and avoiding direct contact with soil is advised.

Be cautious with your eyes, nose, throat, skin et cetera and visit doctor immediately if symptoms are identified. Black fungus spreads through body within a snap of a finger, hence quick action is required. 

For treatment of the infection all the therapies prescribed by the doctors are to be strictly followed. Preventive measures discussed above should be exercised by other family members to avoid infection. As discussed before, early diagnosis is the key to avoid dangerous outcomes.

Apart from this survival of the fittest has always been nature’s rule. Healthy habits must be cultivated to build resilience in the body and mind. According to the Dutch philosopher, Desiderius Erasmus “prevention is better than cure”.


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