BLACK FUNGUS
1. *What is black fungus?*
It is a type of fungus, called Mucor belonging to Mucorales species.
2. *Where it is found?*
Everywhere in environment, especially in decaying materials and in soil, every one of us come into contact with these fungi or its spores on daily basis.
3. *When it causes trouble to us?*
When our immune system becomes dysfunctional, these fungus spores can invade body and cause trouble.
4. *What helps its growth in body?*
Increased glucose (uncontrolled diabetes), increased acidity in the blood (Diabetic Ketoacidosis) and increased availability of iron in the tissues.
5. *How it comes inside our body?
By inhaling the spores of fungus from the environment.
6. *What are the consequences of infection with mucor?*
Infection and destruction of tissues, initially inside nose, then can spread to mouth, eyes, and brain and to various organs along the blood. Can cause damage to lungs, stomach, kidneys and widespread disease.
7. *What are the common instances where it is seen?*
Uncontrolled diabetes, blood cancers and bone marrow transplantation, kidney and other organ transplantations, premature babies, war injuries in soldiers, natural disasters like tornados and hurricanes.
8. *Can it be treated?*
Yes, but success depends on stage at which it has been diagnosed and the underlying disease. The death rates hover around 20 to more than 80%.
9. *Is this infection common?*
No, till the COVID pandemic started, the incidence of mucor disease was around 0.1-2% in high risk patients. The chance that a normal person will have mucor infection is almost near to zero.
10. *Is steroid therapy during COVID responsible for new occurrence of cases?*
Answer is yes and no both. Yes, steroids suppress the immune system and predispose the body for fungal infections. However, the dose of steroids used in treatment of COVID patients is miniscule as compared to steroid use in blood cancers or in rheumatological conditions. We do not see Mucor so commonly in those patients.
11. *Are there any other risk factors for mucor infection in COVID patients?*
Yes, the other responsible factors are uncontrolled sugar and use of higher antibiotics to treat pneumonia.
12. *But, steroids and higher antibiotics are used in other patients also, but there we don’t see Mucor so commonly?*
Very apt observation. Not many answers are known. My take is that these patients are put on high flow oxygen. Now when Oxygen is gushing along the nostrils with high speed, it erodes the protective lining of nose exposing the inner tissues to environment. The mucor easily lodges on these broken surfaces. Now, almost all severe COVID patients have up regulation of an Iron protein called Ferritin which acts as a nice fodder to this fungus. Couple it with immunosuppression by steroids and increased sugars (many are put on glucose drips also), the fungus has feast for itself…it just grows, erodes blood pipes and spreads to brain, eyes and other organs. Though SARS CoV2 belong to a group of petty viruses called Corona Viruses which cause common cold, I feel it is functionally more similar to HIV. COVID itself can cause immunodeficiency with lymohocytopenia and monocytopenia (that is reduction in number of certain cells in the blood which give us protection) and hence Mucor is more common in COVID patients.
13. *Is there anything I can do to prevent this infection?*
Avoid sweets and sugary drinks during COVID illness. Try to change the oxygen tubes frequently, if not possible, request healthcare staff to clean the tubes. Avoid putting tap water to humidify the oxygen. Only sterile water has to be used. The humidifier also needs to be cleaned frequently so that molds do not grow inside. Clean the oxygen cylinder before using it. Keep the patient in a well-lit and aerated room. If there are any objects which can dampen like used clothing, wet wooden furniture, objects on which molds have grown etc. should be taken away from patients room. Do not use wet cloths and try to change the bed sheets as and when they get soiled.
14. *What are the early symptoms of mucor infection which I need to tell my doctor?*
Pain inside or surrounding nose, nose blocks, pain on one side of the face, one-sided headache, swelling or numbness, blurring of vision, toothache and loosening of teeth are some of the early symptoms which need to be told to the doctor immediately.
15. *How can I treat this infection?*
You and I cannot treat this condition at home…this disease needs specialist care… seek immediate help from a physician or ENT surgeon…treatment of Mucor is the domain of specialists only. It requires combination of surgery and prolonged antifungal therapy which may last up to 4-6 months.
16. *My relative at home had black funfus infection. I’m worried what will happen to me or the kids at home?*
What needs to be done to prevent it from spreading others?
Unlike SARS CoV, mucor is not transferred from one person to another person. Those who are healthy need not worry of contracting the disease. Even if there are some persons who are taking steroids for other purposes at home, we need not worry. They are at risk only if they also need high flow oxygen or if they develop COVID.
17. *Is it true that if you take COVID vaccine also you can get this infection?*
No, absolutely not…this fungus doesn’t trouble those who take COVID vaccine. In fact taking the vaccine early is one of the ways you can protect yourself from severe COVID and subsequent BLACK FUNGUS infection.
Dr *Prashantha B*
Consultant Hematologist
KMC Hospital,
Ambedkar Circle, Mangalore