What is Mucormycosis & How Is It Complicating the COVID Situation?

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Many people recovering from COVID-19 have of late been afflicted by black fungus – or mucormycosis – disease, reports the Wire.

The fungus invades the sinus and makes its way into the intraorbital and intracranial regions. If its progression is not checked early, 50-80% of patients could die.

What is black fungus?

It is a rare infection called mucormycosis that is proving fatal to patients suffering or recovering from Covid-19. If its progression is not checked early, 50-80 per cent of patients could die.

Mucormycosis is a fungal infection that mainly affects people who are on medication for other health problems that reduces their ability to fight environmental pathogens. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air.

Symptoms

The symptoms depend on which part of the body is affected, though commonly, it affects sinuses, lungs, and the brain. Common symptoms include nasal blockage or congestion, blackish or bloody nasal discharge, blackish discolouration over the bridge of nose or palate.

  • If the eyes are involved, it can lead to blurred or double vision with pain.
  • If the lungs are affected, then already existing Covid lung symptoms such as shortness of breath, cough, chest pain, and collection of water in the lungs may worsen.
  • Other symptoms include fever, headache, cough, blood vomiting and altered mental status.

The fungus has been all around us for thousands of years. Millions of patients with diabetes, on steroids, or on immunosuppressant medicines have been admitted to hospitals across the country for years with only a handful of cases reported in the last 10 years. There are very few cases of black fungus infection among Covid patients in the USA, Europe or elsewhere. Then why is there a sudden surge in India, that too, during the second wave?

The main reason is prolonged unhygienic oxygen delivery to patients, combined with indiscriminate use of steroids. Patients who are particularly vulnerable are those with uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, and comorbidities such as post-transplant complications, cancer, etc.

However, India has never reported high incidences of black fungus till mid-May, when thousands of cases of black fungus have been reported in patients suffering or recovering from Covid.

The danger

Black fungus is found within our homes and is caused by exposure to mucor mould, which is commonly found in soil, animal dung, rotting wood, plant material, manure and decaying fruits and vegetables.

However, the upsurge we see during the second phase of Covid is because of the completely unhygienic way of delivering oxygen to patients in many places in India, combined with indiscriminate and misguided use of steroids in the treatment of Covid.

There is a vast difference between medical oxygen (MO) and industrial oxygen. MO is a highly purified version that is more than 99.5 per cent pure and is prepared through repeated steps of compression, filtration and purification.

The cylinders in which the liquid oxygen is stored, transported and used are rigorously cleaned and disinfected. This oxygen requires humidification, before being administered to patients; so it is passed through a container filled with sterile water. The water itself must be sterilised and changed frequently as per protocol.

If the water is not sterile, it is potentially a source of black fungus infection. Imagine what this can do to diabetics and non-diabetic Covid-19 patients! No wonder that our overburdened public health system is further burdened.

On the other hand, if oxygen is given without humidification, it will dry the mucous membrane and damage the inner lining of the lungs. It will also make the sputum or secretion very thick to clear out.

The use of steroids in the treatment of Covid-19 has to happen at the right time. Steroids are only effective in fighting the effects of Covid, and not the virus directly. It is dangerous and harmful, if given early, when the virus is replicating.

This will reduce body immunity and facilitate further replication of viruses. Giving steroids unnecessarily or early to a diabetic patient will raise their sugar levels to high, predisposing them to further risk of increase in severity of Covid as well as to the ill effects of black fungus.

The science

The real solution is to make sure that the oxygen delivery receptacle where water is put for humidification is sterilised frequently and distilled water is used. All disposable parts must be frequently changed. There is also a need to stop the indiscriminate use of steroids to minimise this new enemy. A major precaution is to continue tracking sugar levels after Covid patients are discharged.

The second thing is to recognise that we experience fungi in our kitchens, when fruits rot or the bread turns moldy. Fungi evolved 400 million years ago and play an important role on Earth.

The great Irish famine of 1845 that left over 10 lakh people dead was due to the fungus Phytophthora Infestans, which wiped out an entire potato crop in the country. We cannot make the mistake of taking the black fungus lightly.

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Source: The Wire 

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