Neo-Pandemic: Black Fungus

THE SPECTRUM OF MUCOR SPECIES

This recent fungal outbreak has taken the entire country by consternation. The Black Fungus is caused by a multitude of mould species, which all belong to the same family. Collectively, all these species constitute the Mucormycetes fungi and hence, its called as Mucormycosis.

These moulds are usually present in air and moist surfaces. They are relatively harmless. However, in certain high risk cases, it may transform its course to a fatality.

  • Uncontrolled Diabetes
  • Organ or Stem cell transplant
  • Carcinomas
  • Weak Immune System
  • Patients on long term or heavy doses of steroids and antibiotics
  • Persistent neutropenia (presence of longstanding infections)
  • Iron overload
  • IV drug use

Infection Spread

The infection spreads through inhalation, ingestion or inoculation of fungal spores. The infection presents itself in five basic types: sinuses and brain, lungs, digestive tract, skin and disseminated. The various presentations of the disease may present itself as:

Abdominal, Sinuses & Pulmonary

Headache

Nasal Discharge and congestion

Cough & Dyspnoea

Chest Pain

Abdominal Pain

Nausea & Vomiting

Cutaneous & Ocular

Unilateral facial swelling

Cutaneous black coloured lesions

Black lesions on the hard palate

Visual disturbance

Drainage of black pus from eyes


Infection Diagnosis

The diagnosis of the infection is usually based on clinical features. However, a definitive diagnosis can only be based on a histopathological or positive culture testing. Radiological advancements have little value in detecting the infection. CT Scans are of value in diagnosis of pulmonary involvement, but cannot be relied upon to diagnose the Rhino-cerebral involvement. The latter can be better detected through an MRI scan.

It is believed that the outbreak is caused due to the contaminated nasal swabs used during RT-PCR testing. Experts report that about 60% patients who contracted the infection, did not receive steroids or oxygen therapy during Covid treatment.

Trends in the US and UK also report that even after receiving high doses of steroids and oxygen, the Covid patients did not contract the black fungus. This can be explained on the basis that the nasal swabs used there are highly sterilised using gamma radiations, however, there is no quality control over the swab production in India.

Why does the fungi spread rapidly in Covid 19 patients?

1. Patients receive high doses of steroids and oxygen therapy

2. They have a weak immune system

3. Medications used for Covid infection pushes up the sugar levels in diabetic and non-diabetic individuals


Prevention

The best possible way to beat the fungus is to keep yourself protected form contracting it at all. Prevention doesn’t even require much, just maintenance of cleanliness and usage of sterile eqipments.

  • Keep away from damp and dusty places (people who have recently recovered from COVID 19 infection)
  • Patients who have recently recovered from the disease, should try and cover their hands and feet and wear a three ply mask.
  • Regular use of mouth wash
  • Disinfection of toothbrushes and tongue cleaners everyday with antiseptic mouthwashes.

Treatment Protocol

A. Reversal of the underlying disease The aim is to prevent or reverse the underlying defect in the host’s defence.

Patients receiving immunosuppressive drugs (Corticosteroids), need a dose reduction and if possible, aggressive termination of the medication.

Rapid restoration of Euglycemia and maintanance of normal acid-base balance in diabetic individuals.

Minimising blood transfusions to prevent iron overload.

B. Surgical Intervention Thrombosis of blood vessels leads to tissue necrosis, which ultimately leads to impenetrability of the anti fungal agents to site of necrosis. The mainstay of therapy involves surgical debridement of the necrotic tissue.

C. Antifungal Therapy Polyenes are considered the gold standard of pharmacotherapy for Mucormycosis. Liposomal Amphotericin B (L-AmB) is less nephrotoxic as compared to the non lipid counterparts and has shown better survival rates (67%) as compared to 39% with non lipid preparations. Maximum permissible dosage for L-AmB is 3-10mg/kg/day.

Amphotericin B is not fungicidal and therefore, patients receiving this medication need to be on Azole or Sulphonamide therapy to prevent relapse.

Adjunctive Immune therapy involves the co administration of recombinant granulocyte colony stimulating factor (rG-CSF) or recombinant Interferon gamma (rIFN gamma), along with L-AmB.


Mucormycosis, is the new outbreak in the country, that could have been prevented by following proper hygiene standards. Proper sanitisation protocols ensure a clean fungus free substrate that is unsuitable to harbour the vast array of fungal species.

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