Sonia Kanotra
Mucormycosis or Blackfungus, a rare infection before the onset of the Covid 19 pandemic, has become a household name. It is an acute rapidly progressing fatal disease which commonly affects the nose, sinuses and brain but rarely it also involves lungs, gastrointestinal tract and skin. The disease is caused by a fungus that belongs to the family Mucorales. These molds are ubiquitous.
They are found in soil, compost, animal dung, in and around construction sites and on rotting fruits and vegetables, more so in hot and humid environment.
Important thing to understand is that it is not a communicable disease.
Infection occurs by inhalation of spores of the fungus and the disease manifests in people with weakened or Low immunity. High risk groups include uncontrolled diabetics especially those with kidney involvement; the undernourished; those on drugs which impair the immunity e.g., those who have undergone organ transplants and cancer patients. Non-diabetics are not immune to this disease but their chances of contacting the same are low. Black Fungus can also invade the body through cuts and burns in the skin. The fungus rapidly multiplies in the blood vessel wall and cuts off blood supply to the tissues where it grows and thereby causes a widespread tissue destruction/damage.
Covid 19 infection in present scenario has caused a surge in the mucormycosis cases and thus it has been declared an epidemic under the epidemic disease act 1897.An important factor responsible for this surge is the widespread use of steroids along with the hyperglycemic state induced by the covid -19 infection specially this present mutant strain B.1.617.
It is no secret that there is an indiscriminate /irrational use of steroids and antibiotics in present situation where many people do self-treatment with advice from social media, acquaintances or their local doctor (who is usually the neighborhood chemist or the village quack). So much is the hype and stigma attached to Covid 19 that those with mild form of covid infection are being prescribed steroids (Medrol, dexamethasone etc.). There is no doubt that steroids are life-saving drugs but their used has to be guarded and supervised as injudicious use can do more harm than good. It is high time that drug controlling authorities take a serious note of over the counter use of the prescription schedule -H drugs. Steroids lead to high blood sugar levels not only in diabetics and also in non-diabetic covid patients. While many people ,due to lack of routine health check ups in our society, are not even aware of them being diabetic; several diabetic patients being confined to their homes during lockdown were not able to control their disease because of several reasons like lack of exercise, fear of going to the hospital or the doctors clinic or the lab and not taking proper diet precautions or medication, and addition of steroids in these patients leads to uncontrolled sugar levels . This causes a immune compromised state in these already sick patients leading to increase susceptibility to this opportunistic fungal infection. This is further aggravated by the drugs used for treatment of covid-19 infection which provides the perfect platform for this fungus to grow and invade the organ of involvement.
One more culprit in advancing the black fungus is the indiscriminate use of broad spectrum antibiotics which though sometimes are essential in preventing secondary bacterial infections by killing dangerous bacteria but their excessive use weakens the compromising our immune system.
Black fungus is a life threatening disease which despite aggressive surgical treatment and antifungal therapy has a mortality of 40-60%.
Symptoms and signs in covid patients may appear during the hospital stay but usually appear 12-15 days after recovery and vary according to the part of body affected. It commonly affects the nose and the sinuses. Untreated, it can spread to the eye, thepalate, the upper jaw and the brain. Symptoms include nasal stuffiness, discharge and bleeding from nose,tooth ache, headache, swelling around the eye and nose, lack of sensation on face and change in colour (blackening) of skin. Eye involvement causes blurring of vision, double vision, pain, bulging eyes and leads to loss of vision with subsequent involvement of the brain causing severe headache, fever, drowsiness and death. When the spores are inhaled and reach the lungs, symptoms like chest pain and cough are seen. Chest involvement is to be suspected If a covid-19 patient is improving and suddenly starts having increase in the respiratory symptoms.
Treatment includes aggressive surgical debridement which may include removal of part of the palate, nose, skin of the face, upper jaw and even the eye. This is combined with antifungal therapy which may last for several weeks. This medication can have significant side effects.
Black fungus is an aggressive and fatal infection with high morbidity and high mortality especially in high risk population. However, early diagnosis and management can save lives and prevent lifelong disfigurement.
Prevention
* Early recognition of the disease — A high index of suspicion and recognition of early warning signs can help reduce the mortality and morbidity.
* Proper and judicious use of steroids along with control of blood glucose levels under medical supervision is the key factor in prevention.
* The patients and their caregivers must be informed about the possible early signs of the disease so that they can seek prompt medical help.
* Staying indoors, regular exercise, using N-95 masks, avoiding contact with soil and plants, keeping the home clean and damp free,
* Meticulous personal hygiene, maintaining good oral hygiene by regular betadine gargles,
* Monitoring blood sugar levels regularly and in case oxygen therapy is required, use of disposable masks and sterile water in the humidifiers can go a long way in prevention of this dangerous malady.
(The author is Professor Department of ENT GMC Jammu)
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