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Mucormycosis

A rare but serious invasive fungal infection, known as mucormycosis and colloquially as “black fungus”, is being detected relatively frequently among Covid-19 patients in some states. Mucormycosis mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. The disease often manifests in the skin and also affects the lungs and the brain. It can also occur on the skin after a cut, burn, or other type of skin injury. With a number of mucormycosis cases detected in Delhi, Maharashtra and Gujarat.


What is Mucormycosis ?

  • Mucormycosis (sometimes called zygomycosis) is a serious but rare, aggressive and invasive fungal infection caused by a group of molds called mucormycetes.

  • These fungi live throughout the environment, particularly in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood.

  • People get mucormycosis by coming in contact with the fungal spores in the environment. For example, the lung or sinus forms of the infection can occur after someone breathes in spores.

  • These forms of mucormycosis usually occur in people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.

  • Mucormycosis can also develop on the skin after the fungus enters the skin through a cut, scrape, burn, or other type of skin trauma.

Types of Mucormycosis

  • Rhinocerebral (sinus and brain) mucormycosis is an infection in the sinuses that can spread to the brain. This form of mucormycosis is most common in people with uncontrolled diabetes and in people who have had a kidney transplant.

  • Pulmonary (lung) mucormycosis is the most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant.

  • Gastrointestinal mucormycosis is more common among young children than adults, especially premature and low birth weight infants less than 1 month of age, who have had antibiotics, surgery, or medications that lower the body’s ability to fight germs and sickness.

  • Cutaneous (skin) mucormycosis: occurs after the fungi enter the body through a break in the skin (for example, after surgery, a burn, or other type of skin trauma). This is the most common form of mucormycosis among people who do not have weakened immune systems.

  • Disseminated mucormycosis occurs when the infection spreads through the bloodstream to affect another part of the body. The infection most commonly affects the brain, but also can affect other organs such as the spleen, heart, and skin.

Out of these types of Mucormycosis, currently Rhino-orbito-cerebral disease seen in major infected patients.


How does it affect?

  • It can affect various organs but is currently manifesting as an invasive rhino-orbito-cerebral disease, crawling through the sinus and working its way to the brain, affecting the ear, nose, throat, and mouth.

  • It is not contagious, it can cause a lot of damage internally and can be fatal if not detected early.

  • Sudden increase in the invasive form of the sinus variant, which involves the orbit, and at times the brain, leading to blindness, stroke or death, as per the reports from Madras ENT Research

Symptoms of rhinocerebral (sinus and brain) mucormycosis-

  • One-sided facial swelling

  • Headache

  • Nasal or sinus congestion

  • Bloody, blackish, or brown discharge from the nose

  • Blackish discolouration of the skin

  • Swelling or numbness around the cheek

  • Jaw pain

  • Tooth ache

  • Drooping of the eyelids

  • Double Vision

  • Redness of eyes

  • Sudden decrease in vision

  • Black lesions on nasal bridge or upper inside of mouth that quickly become more severe

  • Fever

Who gets mucormycosis?

Mucormycosis is rare, but it’s more common among people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. Certain groups of people are more likely to get mucormycosis, including people with:

  • Diabetes, especially with diabetic ketoacidosis

  • Cancer

  • Organ transplant

  • Stem cell transplant

  • Neutropenia (low number of white blood cells)

  • Long-term corticosteroid use

  • Injection drug use

  • Too much iron in the body (iron overload or hemochromatosis)

  • Skin injury due to surgery, burns, or wounds

  • Prematurity and low birthweight (for neonatal gastrointestinal mucormycosis)

Prevention-

  • Protect yourself from the environment. It’s important to note that although these actions are recommended, they haven’t been proven to prevent mucormycosis.

  • Try to avoid areas with a lot of dust like construction or excavation sites. If you can’t avoid these areas, wear an N95 respirator (a type of face mask) while you’re there. .

  • Avoid direct contact with water-damaged buildings and flood water after hurricanes and natural disasters.

  • Avoid activities that involve close contact to soil or dust, such as yard work or gardening.

  • Wear shoes, long pants, and a long-sleeved shirt when doing outdoor activities such as gardening, yard work, or visiting wooded areas.

  • Wear gloves when handling materials such as soil, moss, or manure.

  • To reduce the chances of developing a skin infection, clean skin injuries well with soap and water, especially if they have been exposed to soil or dust.

  • Keep blood sugar levels under control and ensure that appropriate calibration of oral drugs or insulin is done time to time.

Treatment-

  • Mucormycosis is a serious infection and needs to be treated with prescription antifungal medicine, usually amphotericin B

  • Surgery to remove the fungus growth might also be warranted.

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