Mucormycosis or Black Fungus is being reported in some Covid-19 patients during or after recovery.

As many as 2000 people have been affected by this fungal infection in Maharashtra out of which 10 people have succumbed to it. The disease has also been reported from Delhi and Madhya Pradesh. This has prompted the Indian Council of Medical Research (ICMR) to issue a special advisory on the subject.

What causes Mucormycosis?

According to an advisory issued by the Indian Council of Medical Research, the following conditions in Covid-19 patients increase the risk of mucormycosis infection:

*Uncontrolled diabetes

*Weakening of immune system due to use of steroids

*Prolonged ICU/hospital stay

*Co-morbidities / post organ transplant / cancer

*Voriconazole therapy (used to treat serious fungal infections)

How it is related with Covid-19? 

The treatment of Covid-19 involves intake of drugs like dexamethasone, which suppress our immune system response which results in  the body failing ward off black fungus,

In addition, Covid patients undergoing oxygen therapy in ICU, where humidifier is used, are prone to fungal infection because of exposure to moisture.

But this does not mean that every Covid patient will get infected by Mucormycosis. The disease is uncommon in those not having diabetes.

The disease can be fatal if not treated promptly. Chances of recovery from black fungus depend upon early diagnosis and treatment.

What are the common symptoms?

Mucormycosis begins to manifest as skin infection in the air pockets located behind our forehead, nose, cheekbones, and in between the eyes and teeth. It then spreads to eyes, lungs and can even spread to the brain. It leads to blackening or discoloration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing of blood.

The Indian Council of Medical Research has advised that one must seek medical help for detecting fungal infection instead of jumping to conclusions. 

Best way of keeping black fungus away

Controlling diabetes is one of the foremost prevention methods suggested by ICMR. Hence, Covid-19 patients who are diabetic need to take utmost care.

Self-medication and over-dosage of steroids can result in fatal events and hence doctor’s prescription should be strictly followed.

Member (Health), NITI Aayog, Dr. V.K. Paul says: “Steroids should never be administered at an early stage of COVID-19. It should be taken only after the sixth day of infection. Patients should stick to appropriate doses of the drugs and take the drug for a specific number of days as advised by the doctors. Rational use of medicines should be ensured to avoid adverse side effects of the drug.”

“Other than steroids, use of COVID-19 drugs such as Tocilizumob, Itolizumab also suppress the immune system. And when these drugs are not used appropriately, it increases the risk, as our immune system fails to fight the fungal infection.” Dr. Paul adds.

ICMR in its guidelines has also advised COVID-19 patients to discontinue immunomodulating drugs, a substance that stimulates or suppresses the immune system. The National COVID-19 Task Force has revised the dosage of Tocilizumab to prevent any such adverse effects. Maintaining proper hygiene can also help keep the fungal infection away.

For patients on oxygen therapy, it should be ensured that the water in the humidifier is clean and is refilled regularly. Attention should be paid to ensure there is no leakage of water (to avoid wet surfaces where the fungus can breed). Patients should maintain proper hygiene by keeping their hands as well as body clean.

How is it treated?

While the infection may just begin with a skin infection, it can spread to other parts of the body. Treatment involves surgically removing all dead and infected tissue. In some patients, this may result in loss of upper jaw or sometimes even the eye. Cure may also involve a 4-6 weeks course of intravenous anti-fungal therapy.  Since it affects various parts of the body, treatment requires a team of microbiologists, internal medicine specialists, intensivist neurologists, ENT specialists, ophthalmologists, dentists, surgeons and others.

Be on guard after Covid recovery as well

After recovering from Covid-19, one should closely monitor and should not miss any warning signs and symptoms mentioned above, as the fungal infection is found to emerge even weeks or months after recovery. One should make judicial use of steroids as per doctor’s advice to avoid risk of infection. Early detection of the disease can ease the treatment of the fungal infection.

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