BLACK FUNGUS DISEASE MUCORMYCOSIS

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 BLACK FUNGUS DISEASE MUCORMYCOSIS

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• Second shock: As the second wave of COVID-19 continued to rage across India, many parts have begun witnessing the resurgence of COVID-19-induced “black fungus” cases. This fungal infection, which caused many patients to lose their eyesight in 2020, emerged in several hospitals in Delhi and Gujarat first. This poses extra load on the hospitals and medical system of India, and government must plan relief in this direction.
• What is black fungus: Black fungus, also mucormycosis (previously zygomycosis), is a serious but rare fungal infection. According to the Centre for Diseases Control and Prevention (CDC), mucormycosis cases have an overall all-cause mortality rate of 54%. This rate varies depending on the underlying patient condition, type of fungus, and the body site affected.

1. Since the beginning of the pandemic, the black fungus has pushed several COVID-recovered patients back into the ICUs. The infection causes excruciating pain and has even led to blindness among 20-30% of the infected individuals.
2. The loss of eyesight is caused when the fungus grows behind the eye, thereby compressing the optic nerve.

• BASICS

1. Mucormycosis is a fungal infection caused by fungi in the order "Mucorales". The condition is informally referred to as black fungus.
2. Mucorales is the largest order of zygomycete fungi. Members are called pin molds
3. Species in the Mucor, Rhizopus, Absidia, and Cunninghamella genera are most responsible
4. Mucoralean species are saprotrophic, and grow on organic substrates (such as fruit, soil, and dung)
5. Some are parasites or pathogens of animals, plants and fungi. A few cause human and animal disease zygomycosis, as well as allergic reactions.
6. In this disease, the "hyphae" grow in and around blood vessels and can be potentially life-threatening in diabetic or severely immunocompromised individuals
7. A hypha (plural hyphae) is a long, branching filamentous structure of a fungus. In most fungi, hyphae are the main mode of vegetative growth, and are collectively a "mycelium"
8. An "aspergilloma" is a clump of mold which exists in a body cavity such as a paranasal sinus or in the lung, caused by fungi of the genus Aspergillus
9. Mucormycosis infects the sinuses (nose), brain, or lungs (and the gastrointestinal tract, skin, and other organ systems)
10. The rich blood vessel supply of maxillofacial areas prevents fungal infections, although more virulent fungi, such as those responsible for mucormycosis, can often overcome this
11. Threat factors for mucormycosis include HIV/AIDS, uncontrolled diabetes mellitus, cancers (lymphomas), kidney failure, organ transplant, long term corticosteroid and immunosuppressive therapy, cirrhosis energy malnutrition
12. If mucormycosis is suspected, amphotericin B therapy is immediately administered due to the rapid spread and high mortality rate of the disease

• What causes black fungus: This is caused by a group of molds called "mucormycetes". These fungi are naturally present in the environment, especially in soil and other decaying organic matter like leaves, compost piles, and animal dung. Since most people come in contact with microscopic fungal spores every day, it is almost impossible to completely avoid these mucormycetes. Avoiding direct and close contact with soil, dust, and polluted water could lower one’s chances of developing mucormycosis.
• Who can get infected: For most people with functional immune systems, black fungus presents no threat. Individuals with low immunity are particularly vulnerable - it has been a cause of disease and death for transplant and ICU patients for a long time.

1. Today, the infection is especially affecting COVID-19 patients with weakened immunity and high blood sugar. 
2. COVID-positive individuals with added comorbidities like diabetes, cancer, and kidney or heart failure, along with COVID patients that are being treated using steroids, also feature on the list of rapidly rising black fungus cases of late.

• How does it spread: Mucormycosis is not contagious, and cannot transmit between people and animals. Individuals contract this infection by coming in contact with the fungal spores in their environment. If inhaled, the spores can infect the lungs or sinus. If the fungus enters the skin through a cut, scrape, burn, or other types of skin trauma, mucormycosis can also develop on the skin. The infection can subsequently spread to the bloodstream, and reach organs like the brain, heart and spleen as well.
• Outbreaks: While most cases of mucormycosis are sporadic, outbreaks of mucormycosis have occurred in the past. In healthcare settings, healthcare-associated mucormycosis outbreaks have been linked to adhesive bandages, wooden tongue depressors, hospital linens, negative pressure rooms, water leaks, poor air filtration, non-sterile medical devices, and building construction. Community-onset outbreaks have also been associated with trauma sustained during natural disasters.
• Symptoms of mucormycosis: According to the US CDC, the symptoms of mucormycosis depend on where the fungus is growing in the body. For rhinocerebral (sinus and brain) mucormycosis, the symptoms are one-sided facial swelling, headache, nasal or sinus congestion, fever, and black lesions on the nasal bridge or upper inside of the mouth that quickly become more severe. For pulmonary (lung) mucormycosis, the symptoms include fever, cough, chest pain, and shortness of breath. Early recognition and diagnosis of this infection, followed by prompt administration of appropriate antifungal treatment, are crucial for improving outcomes for patients with mucormycosis.
• Treatment: This serious infection needs to be treated with prescription antifungal medicine, usually amphotericin B, posaconazole, or isavuconazole. These medicines can be taken orally or through IV. The infection often requires surgery to cut away the infected tissue.

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