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Understanding Black Fungus Disease: Decoding Complications

Following the announcement by the Union Ministry of Health and Family Welfare that all states must report and record both suspected and confirmed black fungus cases to the Integrated Disease Surveillance Program, several questions have been raised about what exactly is this disease that has witnessed a worrying increase in the total number of cases. 


Alternatively known as ‘Mucormycosis’, it is a rare disease which is rapidly spreading across the country and is found relatively frequently in the patients diagnosed with covid-19. This has further caused an additional load on the existing pressure on the healthcare system of the country. 


 


WHAT IS MUCORMYCOSIS ? 


Mucormycosis is a fungus that causes blackening or colouring of the nose, impaired or double vision, chest pain, breathing problems, and bloody coughing. It is a dangerous infection, despite its rarity. It is caused by a group of moulds known as ‘mucormycetes’. According to scientists from the Covid-19 task force task team, it primarily affects people who are taking medicine for health issues that specifically affects their ability to resist environmental germs.


After inhaling fungal spores from the air, such people's sinuses and lungs become infected. In several states, doctors have seen an increase in the occurrences of mucormycosis among persons hospitalised or recuperating from Covid 19, with some of them requiring emergency surgery. Mucormycetes do not usually pose a significant hazard to people who have a healthy immune system. 


The disease is linked to diabetes and immune system disorders. Experts strongly believe that the rise is due to an overuse of particular immune-suppressing medicines during the COVID-19 epidemic.


According to Dr Laxman Jessani, Consultant, Infectious Diseases, Apollo Hospitals Navi Mumbai, “The illness isn't communicable and doesn't transmit from person to person. Mucormycosis, sometimes referred to as black fungus, is a misnomer. It is not a true black fungus because, unlike other black fungi like dematiaceous mushrooms, it does not produce melanin pigment. It's known as black fungus because it causes black tissue necrosis.”


The US Centers for Disease Control and Prevention states that the mucormycosis disease has a 54 percent fatality rate, which varies based on the patients' health and the body part affected.


In recent weeks, states throughout India have reported more than 5,000 cases of the normally unusual disease, largely in people who have been infected with COVID-19 or are recovering from it.


 


WHAT ARE THE WARNING SIGNS TO LOOK OUT FOR?


Pain and redness around the eyes and nose, fever, headache, coughing, bloody vomit, black and bloody nasal discharge, pain on one side of the face and in the sinuses, blackish discoloration over the nose, tooth pain, painful and blurred vision and double vision, are all symptoms of mucormycosis. The majority of mucormycosis infections also reported a protrusion of eyeballs which has been observed in Covid patients who have diabetes or who have undiagnosed high blood sugar.


It is a matter of utmost necessity to detect a fungal infection as soon as possible. The infection usually begins in the nose and progresses to the cheeks, palate, eyes, as well as the brain. To minimise complications, an immediate appointment with a doctor is advisable.


 


HOW ARE BLACK FUNGUS CASES TREATED?


Mucormycosis can be treated with antifungals, although it may eventually require surgery. Controlling diabetes, reducing steroid use, and discontinuing immunomodulating medicines are all critical, according to doctors. The treatment includes an IV infusion of normal saline (IV) followed by an infusion of amphotericin B and antifungal medication for at least 4-6 weeks to maintain appropriate systemic hydration.


Experts on the task group emphasised the importance of controlling hyperglycemia and monitoring blood glucose levels after Covid-19 treatment, as well as in diabetics. Steroids should be used with caution – the right time, dose, and duration are crucial.


Microbiologists, internal medicine specialists, intensivist neurology, ENT experts, ophthalmologists, dentists, maxillofacial/plastic surgeons, and others work together to treat Covid patients with mucormycosis.


 


WHAT ARE THE NECESSARY PRECAUTIONS?


Patients with diabetes, patients on immunosuppressants and steroids, or those who suffer from any condition affecting the immune system should take precautions, such as limiting high blood sugar levels, routinely monitoring blood sugar levels, and only using steroids and antifungal drugs when prescribed by a doctor.


People should start using goggles and facial protection, while also following other normal Covid appropriate behaviour and instructions including wearing masks, maintaining physical distance, and often washing hands with soap, due to the strong and expanding Covid-eye connection.


Immunity, on the other hand, is quite important. It also aids in the speedy recovery of patients who have been infected. As a result, one should not skimp on proper nutrition, and ensure that they stay hydrated at all times, exercise on a regular basis, and get adequate sleep. Diabetic patients must monitor their blood glucose levels at all times.


Avoiding dusty construction sites and touching soil, moss, and manure exclusively with gloves are some of the additional precautionary steps the public can take against mucormycosis. When gardening, one must wear shoes, long trousers, and long-sleeved shirts. Taking thorough scrub baths to maintain personal cleanliness is also beneficial.It is imperative to educate patients about the symptoms because this will aid in the early discovery of the ailment.


 


IS THE FREQUENCY AT WHICH THE CASES ARE BEING REPORTED A SUBJECT OF WORRY?


At a press conference, Niti Aayog member Dr V K Paul said “there had been no large outbreak and that they were monitoring the instances reported.”


According to the latest government data, the country has recorded 11,717 cases of "Black Fungus" or Mucormycosis, with Gujarat, Maharashtra, Andhra Pradesh, Madhya Pradesh, and Telangana having the largest number of cases.


In India, 90 people who recovered from COVID-19 died of mucormycosis, prompting requests for a mucormycosis epidemic to be declared by India's health officials.


Patients who have been treated with steroids and other medications for Covid 19 to reduce inflammation are the most sensitive to mucormycosis. Dr. Soman added that efforts are being made to collect data for significant studies being conducted by the Fungal Infections Study Forum and the Clinical Infectious Diseases Society.


 


WHAT IS THE LINK BETWEEN BLACK FUNGUS CASES AND CORONAVIRUS?


COVID-19 weakens the immune system, making it difficult for the body to fight illness successfully. As a result, those who have recovered from COVID-19 are at risk of developing mucormycosis.


Furthermore, oxygen therapy for persons with severe COVID-19 might dry up the nasal cavity, increasing the risk of infection. 


In a report by the Medical News Today that spoke with Christopher Coleman, an assistant professor of infectious immunology at the University of Nottingham in the United Kingdom, said, “Because the virus suppresses the immune system as part of its replication cycle, it is unable to clear other bacteria or fungus. HIV, of course, is the most well-known example of this, as it leads to long-term immune suppression. Other viruses, on the other hand, do this over a much shorter period of time, with the immune system only being modestly reduced for a few days or weeks while the virus is there.” 


In the aftermath of a severe increase in COVID-19 cases, India is currently battling a health disaster with black fungus cases and the coronavirus .The cause, according to experts, is a mixture of circumstances. Contaminated oxygen equipment and the usage of steroid medications to treat certain COVID-19 patients could be among these concerns.


 Poor planning for a second wave of COVID-19, misinformation regarding vaccine effectiveness, and loosened social distancing limitations during a season of large gatherings, according to experts, all had a role in the present health crisis.


COVID-19 can cause a variety of opportunistic diseases, including mucormycosis. The effects of coronavirus and its association with other disorders are yet mostly unknown.


 


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