Black fungus: COVID’s vengeance on humanity
What is black fungus infection and how can you prevent contracting it? An expert clarifies
Remove three letters — d, e and m — from the word ‘pandemic’, and the word transforms into ‘panic’.
It’s a fitting analogy especially given the devastation that black fungus, or mucor, has been creating, exacerbating fear in the current wave of pandemic in the already COVID-ridden, panicstricken country.
For the unversed, mucor is one of the most acute fatal fungal infections known to mankind. The fungus, which belongs to the class Zygomycetes, causes the infection called mucormycisis. The most virulent and common species is Rhizopus. Fatality is the result of the unique property of the fungus with regard to vascular invasion (invasion of the blood vessels), blocking the vessel leading to ischemia or the dead tissue.
Normal human serum can inhibit or resist the growth of Rhizopus. However, the serum of a patient with diabetic ketoacidosis may actually enhance the fungal growth, as iron is more readily available in the body in such cases.
So also, COVID infection with uncontrolled diabetes is a deadly combination and has been causing significant increase in the number of mucor cases in India. Patients with renal dialysis and immuno-suppressed (by steroid) are also at significantly higher risk to contract the fungus. Fatality rate is around 50%. Unfortunately, ‘social media prescription’ has led to an unsupervised usage of steroids, which has also contributed to increased number of mucor cases in the country. It is important to understand that one prescription will not fit all.
COMMON SYMPTOMS AND DISEASE MANAGEMENT
Dry nose, crusting in the nose, bleeding from nose, pain in the eye, redness of eye, swelling around the eye, diminished vision or total loss of vision, facial pain and headache especially after COVID infection are all alarming signs. One must seek immediate medical help from an ENT surgeon.
Disease management includes a multi disciplinary approach involving an infectious disease physician, endocrinologist, ophthalmologist, ENT specialist and ana es th es io lo gist, and ahead and neck surgeon, a microbiolologist, pathologist and radiologist.
It is, however, important to remember that early diagnosis and subsequent treatment of the infection is the key for a better outcome. For the early diagnosis, nasal examination with an endoscope and oral cavity examination in the high-risk group must be followed. Biopsy of the suspected tissue from the nasal cavity should be sent for fungal and histopathology study.
Imaging studies for managing the disease include a CT scan for bony erosion and an MRI scan for soft-tissue invasion. Hyperglycemic control is another important step, which involves the removal or correction of the underlying predisposing condition. Some cases also need an aggressive surgical debridement, which may come with lot of morbidity as it may involve removal of the maxilla (the cheekbone) and eyeball if the vision is lost.
Surgery is conducted only to bring down the fungal load, after which it has to be followed by antifungal medication.
THE DRUG OF CHOICE
Amphotericin B has to be used precisely with extreme caution as it causes nephrotoxicity. As most patients are in different stages of diabetic nephropathy, the usage of this medicine should be under strict supervision of a qualified doctor. Longterm follow up is also required after the initial treatment.
It has been particularly observed that in most of the
mucor cases patients have not taken the COVID vaccination. It is probably safe to rationally assume that the vaccine not only helps in preventing serious COVIDrelated hospitalisation but also alleviate post-COVID complications.
Sadly, however, treating mucor is becoming increasingly challenging with limited healthcare infrastructure and the non-availability of key medicines such as Amphotericin B.
THE WAKEUP CALL
The panic button that mucor has set off in these times is a cue for us to start taking our mental and physical health seriously. Having a positive attitude of gratitude, eating nutritious diet, exercising, having optimal exposure to sunlight, hydrating enough to balance the pH of the body, staying in touch with and appreciating and valuing family and friends we love can all add up to
Disease management includes a multidisciplinary approach involving an infectious disease physician, endocrinologist, ophthalmologist, ENT specialist and anaesthesiologist, and a head and neck surgeon, a microbiolologist, pathologist and radiologist.
It’s time we learnt from history. The Spanish Flu pandemic in 1918 had assumedly infected 1/3rd and killed 1% of the world population. The good news regarding the current pandemic, however, is that each of us can contribute to fighting it by wearing a mask, maintaining socialdistance and getting vaccinated.
enormously boosting everyone’s immunity. And that might, in turn, give us a fighting chance in case we are unfortunately exposed to the coronavirus.
All said and done, it is time we learnt from history. The Spanish Flu pandemic in 1918 had assumedly infected 1/3rd and killed 1% of the world population. The good news regarding the current pandemic, however, is that each of us can contribute to fighting it by wearing a mask, maintaining social-distance and getting vaccinated.
(The writer is an ENT Surgeon and Vertigo specialist at the Department of ENT, Head and Neck surgery, Cochlear implant and Vertigo clinic, Apollo hospital, Jubilee Hills)