Mucormycosis (Black Fungus): Fear and facts

By Dr. Hamid Shah –

Mucormycosis previously known as Zygomycosis is rare but serious disease caused by fungus (molds) called mucormycetes.  These moulds are freely distributed in the environment. The disease affects mostly those persons who have any underlying illness or those persons who are on medication that cause disturbance in the immunity. When these fungal spores are inhaled, it then affects the sinuses and lungs or some other organs. It can also occur in cut skin, burn or any other skin injury. It should be noted that the disease is not contagious that is it is not transmitted from person to person or person to animals. Different types of Mucormycosis are:

1. Rhinocerebral mucormycosis affects sinus and brain- Mostly in those persons who are diabetic or who have undergone kidney transplant
2. Pulmonary mucormycosis- Persons suffering from cancer, or who have undergone kidney or stem cell transplant
3. Cutaneous mucormycosis-Occurs when there is break in the skin/cut or trauma
4. Gastrointestinal mucormycosis- This type was recently seen in two patients whose small intestines were affected at Sri Gangaram Hospital Delhi in two male patients aged 56 and 68 years old. Biopsy were done and black fungus were confirmed in the small intestines.

Recently the case of mucormycosis was seen in the Govt. Medical college jammu where 40 years old patient died who was recovered from COVID-19 but was immunocompromised.

Types of fungi which caused mucormycosis are Rhizopus species, Mucor species, Rhizomucor species etc.

Symptoms

The symptoms depend upon the location where fungus is growing.

Rhinocerebral mucormycosis- Unilateral facial swelling, Headache, Nasal/sinus congestion, Black coloured lesion on nasal bridge or upper inside of mouth that becomes severe.

Pulmonary mucormycosis- Fever, chest pain, cough, shortness of breath

Gastrointestinal mucormycosis- Pain in abdomen, Vomiting/Nausea, GI bleeding

Risk Factors

 Some persons are more likely to get Mucormycosis due to underlying illness like-

• Cancer
• Diabetes
• Organ transplant
• Stem cell transplant
• Neutropenia (low number of white blood cells)
• Long-term corticosteroid use
• Excess iron in the body 
• Skin injury due to surgery, burns, or wounds

Where does it comes from?

Mucoromycetes that cause Mucormycosis are mostly present in the environment particularly in soil in association with decaying organic matter such as leaves, composite piles and cow dung. The practice of using cow dung as a protective measure from COVID-19 in most parts of the India will not prevent but further aggravate the occurrence of Mucormycosis.

COVID-19 and Mucormycosis

Mucormycosis has surged in India recently primarily affecting those persons who have recovered from COVID-19, otherwise in last 10 years, doctors have only seen very few cases in india. As SARS COV-2 damages the immune system making affected persons susceptible to Mucormycosis. Some experts have also suggested the continuous use of steroids in the COVID-19 affected individuals can be one of the reason of Mucormycosis in addition to the immunocompromised state of COVID-19 affected patients. The infection is life threatening and has mortality rate between 46-96% which depends on severity. Otherwise in last 10 years, doctors have only seen very few cases in India. There has been an increase in the number of Mucormycosis patients in the last few days causing worry in the government and thus declaring it as notifiable. Gujrat and Tamil Nadu has already declared this disease as notifiable under disease epidemic act.  According to Senior cardiologist Dr Atul Abhyankar, there are certain patients who are not given steroids but yet they develop Mucormycosis, the reason being the humidifier used for giving oxygen. Sterile water should be used instead of tap water which may contain many microorganisms that may lead to the formation of fungus. People should use sterile water instead of tap water and replace the water twice after every 24 hours.

These days the requirement of the oxygen cylinders and concentrator devices for the COVID-19 patients are on great demand. Many NGOs and others provide same for the patients in Kashmir valley, but before using them clean them properly and air dry to prevent the occurrence of disease.

As per, Dr.Nikhil Bhayani infectious disease expert at Texas Health Resources, Mucormycosis can be treated with antifungal agents like amphotericin B, isavuconazole, and posaconazole.

(The writes is Sr. Consultant Microbiologist VETLAB-New Delhi. Feedback at [email protected])