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| EDITORIAL |
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| Year : 2021 | Volume
: 48
| Issue : 2 | Page : 55-56 |
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Mucormycosis (Black Fungus) in COVID-19 times
Shridhar C Ghagane1, Rajendra B Nerli2
1 Division of Urologic-Oncology, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre; Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Belagavi, Karnataka, India
2 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Belagavi, Karnataka, India
| Date of Submission | 31-May-2021 |
| Date of Acceptance | 11-Jun-2021 |
| Date of Web Publication | 18-Aug-2021 |
Correspondence Address:
Rajendra B Nerli
Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Belagavi - 590 010, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jss.jss_70_21
How to cite this article:
Ghagane SC, Nerli RB. Mucormycosis (Black Fungus) in COVID-19 times. J Sci Soc 2021;48:55-6 |
India is in the grips of a severe second wave of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2. This infection has been associated with a wide range of opportunistic bacterial and fungal infections.[1] Recently, there has been a spate of several cases of mucormycosis being reported in patients testing positive for COVID-19 all over the world and more so in India.[2] A complex interplay of factors, including preexisting diseases, such as diabetes mellitus, previous respiratory pathology, use of immunosuppressive therapy, risk of hospital-acquired infections, and systemic immune alterations of COVID-19 infection itself could lead to secondary infections including mucormycosis, which have a huge impact on morbidity and mortality.[3]
Mucormycosis (previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These fungi commonly occur in the environment, particularly in leaves, soil, compost, and animal dung. Mucormycetes can enter the body through breathing, inhaling, and exposed wounds in the skin. Mucormycosis mainly affects people who have health problems or are medications (steroids) that lower the body's ability to fight germs and sickness. It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. It can also occur on the skin after a cut, burn, or another type of skin injury. Individuals with COVID-19 are more prone to getting affected by this fungal infection, more so if (a) They are diabetic and their blood sugar levels are poorly controlled, (b) Have comorbid conditions on immunosuppressants, steroid medications to treat preexisting illnesses, (c) Being treated in the intensive care unit, i.e., ICU wing of hospitals for a prolonged period, (d) Having a vulnerable immune system that is weakened owing to comorbidities such as previous organ transplant surgeries or cancer therapy procedures, (e) Already taking prescription antifungal drugs to combat infections.
Patients affected by mucormycosis also called black fungus present with Sinusitis and clogging of the nasal tract and bloody or blackish mucus emission from the nose, Pain on only one side of the face, cheekbones, with lack of sensation and bulging, Distinct blackish decolouration on the bridge of the nose, Hazy vision, with objects appearing blurred or in double, with eye pain, abnormal blood clotting or thrombosis of tissues, along with skin injury and damage or necrosis of dermal cells, Further deterioration of respiratory functions, with chest pain, excess fluid build-up in lungs, i.e., pleural effusion and coughing up blood or haemoptysis.
Mucormycosis is a serious infection and needs to be treated with prescription antifungal medicine, usually amphotericin B, posaconazole, or isavuconazole. These medicines are given through a vein (amphotericin B, posaconazole, isavuconazole) or by mouth (posaconazole, isavuconazole).[4] Often, mucormycosis requires surgery to cut away the infected tissue. Debridement of necrotic tissue in combination with medical therapy is mandatory for patient survival. In rhinocerebral disease, surgical care includes drainage of the sinuses and may require excision of the orbital contents and involved brain. Repeated surgery may be required, especially for rhinocerebral mucormycosis.
Simple preventive measures go a long way in lowering the chances of acquiring mucormycosis postCOVID-19 recovery, such as, ensuring personal hygiene by bathing and scrubbing the body thoroughly, particularly after returning home from work, working out or visiting neighbours, relatives and friends. Wearing face masks and face shields when going to dirty polluted environments such as construction sites, making sure to don fully covered clothing of concealed shoes, long pants, long-sleeved shirts and gloves while coming in contact with soil, moss, manure, like in gardening activities.
| References | |  |
| 1. | Kubin CJ, McConville TH, Dietz D, Zucker J, May M, Nelson B, et al. Characterization of bacterial and fungal infections in hospitalized patients with coronavirus disease 2019 and factors associated with health care-associated infections. Open Forum Infect Dis 2021;8:ofab201.  |
| 2. | Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: A clinical and diagnostic perspective from China. Mycopathologia 2020;185:599-606. |
| 3. | Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13. |
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