Watch out for Mucormycosis/Black Fungus in COVID-19 Patient

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Black Fungus a rare fungal infection in the past, which had very rare cases in the previous times, has been declared now as an epidemic by Indian health authorities, within the larger Covid-19 pandemic in India. Medically termed as “Mucormycosis”, it has surged in enormous numbers now in India with Covid-19 cases, primarily affecting the people who are recovering from the disease. Unlike coronavirus it’s not a contagious infection, meaning it doesn’t spread from person to person. But it’s a pathogenic fungus which once enters the body making it, as it’s host and starts to spread to different organs within the body, if not identified in the initial stage of infection.

This can prove really deadly as the infection spreads fast within the body fatally striking the essential organs.

NOTE: After reading this article one of my good friends, Dr. Vinod Kumar, advised me to include the following point for everyone’s awareness. I am very thankful to have his valuable input as a medical professional.

According to him, also when black fungus enters the blood vessels - it can cause severe widespread infection all over the body in multiple organs.

Few cases were observed in the first wave of Covid-19 in India last year. But now with the second wave, so many cases are being reported in India, which nobody anticipated that the numbers would be so exponential. As of today India has recorded approximately 11,717 cases of black fungus cases so far and 6 states in India have declared black Fungus as an epidemic disease.

Medically Mucormycosis is still a rare occurrence. This rare infection in pre-covid times, was usually a rare disease which is caused by fungi and molds. These group of moulds are known as mucormycetes. Healthy individuals with good immune system, if infected with this disease can fight against it. But in people with compromised immunity, the same can’t be said as it can spread within the body at a very fast pace if undetected much sooner, leaving no other option but to operate on the infected organ so as to stop the spread further. Amid the second wave of Covid-19 outbreak in India, this “ Opportunistic Fungus”, has become a potent danger for the patients who are already struggling to recover from Covid-19 or patients who have just recovered from Covid-19. It’s an environmental opportunistic pathogen which needs to have a host (i.e. humans) to grow under certain conditions (infected with Covid-19) in an environment (excess usage of steroids, bad sides of oxygen therapy) where it thrives.

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Mucormycosis is affecting Covid patients due to various factors. The major factors that will make it thrive are the high blood glucose levels in the patient (uncontrolled diabetes), lack of oxygen in the body, acidosis, suppressed immunity, vulnerable immune system, unhealthy supply of oxygen through uncleansed, unsterilized humidifiers, prolonged administration of steroids, and unhygienic practises contribute towards its growth and spread in the human body. The mortality rate of this rare disease is said to be 50% percent.

Causes

  • Rampant misuse & a cocktail of antibiotics can make it easy for the virus to breach body’s natural defence making it more vulnerable for black fungus to invade. Health experts are of the opinion that overuse of antibiotics in treating Covid-19 patients is another major cause which leads to invasive fungal sinusitis.
  • Contaminated water used in humidifiers can prove to be dangerously fatal. Humidifier is the bottle used in oxygen cylinders/concentrators, whose function is to prevent the patient’s airways from getting too dry while breathing air through them. The water used in these humidifier bottles through which oxygen is given needs to be sterile and clean. If not as per infectious diseases specialist Dr. Ishwar Gilada the risk of contamination in the patient increases by breathing in fungal spores.
  • The humidity in the nose due to the use of oxygen passing through water, poor and constant use of masks are said to be another probable cause for colonization of fungus in the nose which will lead to affect the sinuses & lungs.
  • Covid patients who are on the ventilators in intensive care units, due to their airways being exposed to humidity and moisture for prolonged periods is another factor. Depending on what part of body is affected, black fungus can get fatal upto 96%.
  • When body is in an immunocompromised state, this opportunistic fungus becomes invasive. The fungal infection is more life-threatening for those with weaker immune systems.
  • Usage of unsterile equipments set the stage for mucormycosis/black fungus. The handling of equipments and their sterilization is extremely important for re-use on another patient. But now due to the scary combination of high load of patients with low oxygen levels & less availability of the oxygen therapy machines, the oxygen cylinders are rotated between patients without following the protocols of disinfection.
  • Usage of poor quality water in humidifiers or oxygen tanks containing dirty water used for patients on oxygen flow — many being treated for Covid-19 is believed to be another reason for the high spurt in cases. Non — sterile waters used in humidifiers prove to be really hazardous.
  • Non-medical grade oxygen cylinders have also played a possible role in the medical grade oxygen shortage crisis.. As per few doctors in Mumbai, the use of industrial oxygen is another reason for the outbreak. Everyone knows that there is a big difference in the making of medical grade oxygen and industrial grade oxygen as the purpose of both these are entirely different. But the acute shortage of medical oxygen in the second wave India is facing urged the doctors in order to save lives resort to industrial oxygen to meet the daily requirements.
  • Overuse of Zinc and Iron supplements are also the factors in the increase of the infection. Over the decades research metal zinc acts as a prominent factor for fungus. Studies have also proven that removing zinc makes it difficult for the fungus to survive. So in order to boost the weakening immunity of a patient struggling with Covid-19 if the zinc and iron supplements have been given that too could have provided an environment for black fungus to thrive.
  • Steam inhalation which is an age old therapy for relieving the congestion in nose when the common cold happens is supposedly not conducive as per experts pertaining to Covid-19 cases. That is because steam inhalation can contribute in creating a warm & damp environment for the fungus to thrive, but it’s not going to be alone the likely factor to contribute. This requires a combination of circumstances like uncontrolled diabetes & usage of steroids.
  • High dose / Overuse of steroids — The sudden rise in black fungus cases are also linked to the use of steroids to treat the Covid-19 patients. In critical times to start the treatment on the patient, high dosage of steroids are administered without having any indication of the high blood sugar levels, this can dangerously cause a case of mucormycosis.
  • Due to hospital staff getting infected by Covid-19 themselves and thus the shortage of nurses & doctors also has been leading to poor & improper monitoring of infection control measures in overloaded hospitals.
  • Other factor attributing to black fungus cases are post Covid-19 unhygienic lifestyle at home too has paved the way for the it to afflict immunosuppressed health conditions. Please do not self medicate yourselves with invasive oxygen therapy, unprescribed steroids & antibiotics.
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Symptoms

  • Facial Swelling
  • Lack of facial sensation
  • Headache
  • Blackening or discoloration over the nose
  • Nasal congestion & breathing problems
  • Coughing blood
  • Fever
  • Blurred vision
  • Vomiting
  • Shortness of breath
  • Chest pain

Remedies

  • Good control of blood sugar levels/ tight control of sugar. Patients recovering from Covid-19 must not loosen up and be aware of the important things they need to ensure during the recovery period/post recovery period.
  • Appropriate usage, treatment & dosage of steroids. Health experts have to be careful about when to give steroids and about the dosage to such patients continuously monitoring them.
  • Patients who are on steroids must be monitor their blood sugar levels regularly & inform their doctor.
  • In between patients all components of the humidifiers must be soaked in antiseptic solution for half an hour, cleansed properly with clean water & dried in air. Overall hygiene must be maintained strictly.
  • Once in a week and in between patients, all components of Humidifiers must be soaked in antiseptic solution for 30 minutes, wash them soap water, rinsed with clean water and dried completely in air before reuse.

All India Institute of Medical Science (AIIMS) director Randeep Guleria has pointed out that those infected or recovering from Covid-19 have the highest risk of getting infected with black fungus within six weeks of getting infected by Covid-19. Therefore it is very important to remain cautious, aware, hygienic and not take the recovery period lightly.

Please note that I am not a doctor by profession but I did a thorough study on the various information provided by renowned doctors and health experts based on which I have written this article. Always consult with your doctor for any condition and never self medicate yourselves based on readings on the internet. This article is only meant to create awareness about black fungus.

I wish to dedicate this article to my late father who was a doctor by profession & who always believed that doctors and health experts around the world should strive to create awareness among patients/people with their expertise and knowledge to make this world a healthier & better place.

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