9 AM to 6 PM : 91 70421 58901 mail: info@enexticu.com
“Black Fungus”: An outbreak in the midst of a pandemic
Home » “Black Fungus”: An outbreak in the midst of a pandemic
Jun
04
2021
Off
“Black Fungus”: An outbreak in the midst of a pandemic
Though the term has become quite famous lately in the print and social media, in strict medical terms, it’s incorrect. The disease that we are concerned about is a form of life threatening invasive fungal infection called “mucormycosis’. It includes infection caused by fungi belonging to the order “Mucorales”.Over 11,700 instances of mucormycosis were reported in India on May 25, 2020, from the beginning of this pandemic.
Is it something new?
Even though most of the people might’ve heard it for the first time, India in fact had the highest number of cases of mucormycosis even before the present pandemic. A research conducted between 2013 and 2015 at four large tertiary care institutions in India found 388 instances of mucormycosis, roughly 56 percent of whom had “uncontrolled diabetes.”The recent surge of cases has been linked to the possibility that CoVID-19 or its treatment acts as a contributory risk factor.
Who is a risk factor?
Traditionally the risk factors have always been
Diabetes Mellitus with or without Diabetic Ketoacidosis
Immunosuppression e.g., use of steroids
Post Solid organ Transplant/Hematopoietic stem cell transplant (HSCT)
Malignancy
Prolonged treatment in an ICU esp. with use of antibiotics and Voriconazole
Malnourishment
Trauma/blast injuries/burns
India has two specific reasons why cases are rising alarmingly
It is the Diabetic capital of the world. According to the survey, the diabetes population in the country is on track to reach 9 million by 2025.
Medications like steroids/antibiotics are unregulated here and available over the counter easily
What has the CoVID-19 pandemic done to above risk factors?
Overuse of steroids in high doses and/or prolonged duration: self-medication
Use of immunosuppressive agents as part of treatment protocols
Worsening of sugar control due to steroid use
Prolonged ICU stays
Lack of care for Non COVID patients which might augment risk factors
When should one suspect?
Pain around the eye or sinuses or nose especially on one side: Sinusitis
Continuous fever without obvious cause
Headache
Persistent cough
Breathlessness
Altered mental state
How to diagnose?
Histopathology: depends on area involved
Of biopsy samples or post excision samples
Swabs or washings
Direct Microscopy
Culture
Radiology of affected part
CT scan head PNS etc.
MRI brain etc.
How to prevent?
Be aware of warning signs
Control sugar levels
Judicious use of steroids and antibiotics /antifungals
Aggressiveness in diagnosis and treatment
Medical
Surgical
Regulated use of immunomodulating drugs
Use of clean and sterile water for oxygen humidifiers
Best management is team work
Treatment should be availed at a center with experts in
Microbiology
Critical care Medicine
ENT
Ophthalmology
Dental
Surgery
Neurology
Internal Medicine
Neurosurgery
How to improve outcomes?
Early diagnosis and treatment are the only effective way in improving outcomes of this disease. Surgery combined with the use of antifungal agents (Liposomal Amphotericin B, Posaconazole, Isavuconazole) when done in the earlier stages is most helpful
Despite all advancements, mortality is still high to the tune of even 90 % in pulmonary and disseminated cases.