10 things you should know about Mucormycosis

Mucormycosis Microscopic image

Mucormycosis is a very serious fungal infection that occurs in people with reduced immunity.  It is also known as Black Fungus Disease. The widespread of Mucormycosis is being observed in recent times due to the rising incidence of COVID-19 infection. According to doctors, Mucormycosis has an overall mortality rate of 50%. 

In this article, we will discuss about 10 facts about Mucormycosis that you need to be aware of. So let’s get straight into the details !!!

1. Mucormycosis is triggered by the use of steroids, a life saving treatment for severe and critically ill COVID-19 infections. Steroids reduce inflammation in lungs for COVID-19 and resist the damage when body’s immune response gets exhausted to fight against Coronavirus. But unfortunately, they reduce the immunity and that results in increase in blood sugar levels in diabetic and non-diabetic COVID-19 patients. Diabetes manipulates the body’s immune defense, Coronavirus aggravate it. Finally, steroids that is primarily aimed at fighting against Covid-19 turns antagonistic. 

2. Symptoms associated with Mucormycosis include pain or redness around eyes or nose, fever, headache, coughing, shortness of breath, bloody vomiting and altered mental status. There are instances of black patches of skin around the nose. 

3. Mucormycosis has variable manifestations that has involvement of multiple organs. Medical fraternities have  reported cases of tracheal, mediastinal, bone, heart, kidney, external auditory canal and corneal involvement. Renal mucormycosis may occur in patients with intravenous drugs abuse or those receiving corticosteroids. Cerebral mucormycosis, often known as brain abscesses that involves sinus infection is typically observed in  patients with illicit intravenous drugs. In all these cases, on time removal of the device and systematic Antifungal therapy is essential for the resolution of infection.   

4. Use of mask is imperative if you are visiting places like construction site, factories or some industrial areas where there is involvement of dust in large amount. Wear shoes, long trousers, long-sleeved shirts and gloves if you are involved gardening work. Maintain personal hygiene including a thorough scrub bath.  

5. Even though most cases of Mucormycosis are sporadic, there are incidences of outbreak of mucormycosis. It can be difficult to determine whether ushering of the disease is eminent from clinical perspective or infections have occurred from some external stimuli. Some sources associated with clinical perspectives include Adhesive bandages, wooden tongue depressors, hospital linens, negative pressure rooms, water leaks, poor air filtration, non-sterile medical devices and construction sites. Trauma sustained during natural disasters is  linked to community onset outbreaks. 

6. Primary treatment for Mucormycosis includes Antifungal therapy. Patients may also require surgery. Doctors suggests utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs. To maintain adequate systemic hydration, the treatment includes infusion of normal saline by intravenous route before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks. The whole management of mucormycosis associated with COVOD-19 involves input from microbiologists, internal medicine specialists, intensivist neurologist, ENT specialists, ophthalmologists, dentists, surgeons, viz.  maxillofacial/plastic and others.

7. Post-surgery, patients often encounter with loss of upper jaw and sometimes even the eyes. Therefore patients may have difficulty in chewing, swallowing, facial aesthetics and loss of self-esteem. Whether it is eye or jaw, it can be replaced with appropriate artificial substitutes or prostheses. Prosthetic replacement is augmented once the patient gets stabilized post-surgery.  

8. Traditionally, we could see a case of Mucormycosis every month. We could see such cases in usually in very poorly controlled diabetic and immunocompromised patients. But in the past couple of months, we have seen cases shooting up in rapid-fire progress. Efforts are underway to collect data for large studies being done by the Fungal Infections Study Forum and Clinical infectious Diseases Society

9. Diagnosis for the Mucormycosis  depends on the location of the suspected infection. A sample of fluid from your respiratory system may be collected for testing in the lab; otherwise a tissue biopsy or a CT scan of your lungs, sinuses etc.  may be conducted

10. Some myths associated with Mucormycosis

a. Person to person transmission: Mucormycosis can not be transmitted from person to person, so there is no need for people to isolate unless they have COVID-19 infection. 

b. Fungi growing in water, oxygen cylinders or Humidifiers: It has been rumored that the fungi must be growing in dirty water in hospital oxygen cylinders or humidifiers. However, there is no scientific evidence that this can occur, and mycologists have pointed out that fungi can not produce spores in fluid. 

c. Face masks aggravate the fungus: There is no scientific evidence that is centered around face mask aggravating the fungus.

Let us know in the comments your reactions for this article !!!

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