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“Black Fungus”: An outbreak in the midst of a pandemic

“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



Critical care Medicine






Internal Medicine


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.