Mucormycosis, previously known as zygomycosis and sometimes termed as black fungus, is a serious fungal infection, found generally in people with less ability to fight infection. As the cases of black fungus infection continue to rise in India, doctors and scientists are worried if there is more to it than just the use of steroids. Symptoms of this infection depend on the part of the body which is infected. It most commonly infects the sinuses and brain resulting in a runny nose, one-sided facial swelling and pain, headache, fever, and tissue death. Other forms of the disease may infect the lungs, stomach and intestines, and skin. It is generally spread by breathing in, eating food contaminated by, or getting spores of molds of the Mucorales type in an open wound.These fungi are frequently present in decomposing organic matter such as rotting fruit and vegetables, leaves, and animal manure, but do not usually have an effect as it is not transmitted between people.
Risk factors for the infection include diabetes, lymphoma, organ transplant, iron overload, HIV/AIDS, and long-term steroids or immunosuppressants use. Diagnosis for black fungus is done by biopsy and culture, with medical imaging to help determine the extent of the disease. Treatment for it is generally done with amphotericin B and surgical debridement and preventive measures include wearing a face mask in dusty areas, avoiding contact with water-damaged buildings, and protecting the skin from exposure to the soil such as when gardening or certain outdoor work. Black Fungus tends to progress rapidly and is fatal in about half of sinus cases and almost all cases of the widespread type. To talk about the disease and to spread awareness for it, experts from Ujala Cygnus Hospital, Columbia Asia Hospital, and Paras Hospital shared their inputs. Dr Amitabh Malik, Chief- ENT, Paras Hospital, Gurugram spoke about the misconceptions among people regarding the disease and said, “The rising incidences and mortality related to black fungus have actually paved the way for lots of misconception and misunderstanding about the fungal infection. People have started alienating the families, whose members are diagnosed with black fungus, thinking it’s a highly contagious infection.”
Speaking further on the subject, he continued, “Black fungus disease is not contagious, which means that it cannot spread from contact between humans or animals. But it does spread from fungal spores that are present in the air or in the environment, which are almost impossible to avoid. Some people also feel that it can happen due to eating fruit. Uncontrolled diabetes along with a Covid infection are the leading causes for a patient to develop black fungus.” Ever since the first few cases of black fungus had been reported, there has been extensive media coverage about it. This has led to fear and confusion among the public about its causes and effects. Mucormycosis, colloquially known as the black fungus, has aggravated the devastating effects of the second wave of the COVID pandemic.
What needs to be understood is that our bodies are constantly attacked by different bacteria and fungi but they are kept under control by our immune system. It is when this immune system is compromised due to unreasonable use of steroids, diabetes, or cancer treatment; it gives a breeding ground to these fungi and bacteria to grow rapidly. Most diabetic patients suffering from COVID-19, who are being given steroids, have a high chance of being affected by the black fungus. To prevent it, people should stop the misuse of steroids. Mucormycosis can affect the face, infecting the nose, the orbit of the eye, or the brain, which can cause even vision loss. Dr Shuchin Bajaj, Founder and Director, Ujala Cygnus Group of Hospitals said that “it can also spread to the lungs. Doctors treating COVID-19 patients, diabetics and those with compromised immune systems should watch for early symptoms including sinus pain or nasal blockage on one side of the face, one-sided headache, swelling or numbness, toothache and loosening of teeth to guard against black fungus infections.” There is also the idea among people that excessive use of steroids is causing the infection.
The expression ‘excessive use of steroids’ can be misleading. Dr Shashank Vashist, Consultant- ENT, Columbia Asia Hospital, Palam Vihar, Gurgaon said, “Steroids are effective in COVID patients who have moderate to severe disease, there is no other way to treat them. However, if steroids are used too early in the disease, it can be counterproductive. Identifying the right time to administer steroids is important and blaming steroids for black fungus can affect treatment of this category of patients.” Another myth that has been doing rounds is that a person can get infected by black fungus by eating raw food. But there is no data available so far to support this claim. Earlier this infection was spotted in patients with uncontrolled diabetes and in immune-compromised patients only. But during this pandemic, patients in the third week of illness, when they are recovering, are found to be affected with black fungus. Hence, it becomes extremely important to circulate the right information about the infection so that all the necessary precautions can be taken with the right kind of treatment at the right time.