Fatal black fungus infection: Do's, don'ts; All you need to know

New Delhi, May 09: The rising number of cases of mucormycosis, a fungal infection commonly known as 'Black Fungus', has triggered panic among many. The fungal infection may turn fatal if not cared for as it weakens immune system of a COVID-19 affected person.

Following the rise in number of cases, the ICMR has released an evidence-based advisory for screening, diagnosis and management of the disease.

What is mucormycosis?

Mucormycosis is a rare fungal infection that is one of the post-coronavirus complications which has been observed in patients. It is a fungal infection that mainly affects people who are on medication for other health problems that reduce their ability to fight environmental pathogens.

Fatal Black Fungus Infection Symptoms

• Pain and redness around eyes and/or nose
• Fever
• Headache
• Coughing
• Shortness of breath
• Bloody vomits
• Altered mental status

Fatal Black Fungus Infection Predisposition

• Uncontrolled diabetes mellitus
• Immunosuppression by steroids
• Prolonged ICU stay
• Co-morbidities - post transplant/malignancy
• Voriconazole therapy

Fatal Black Fungus Infection DO'S

• Control hyperglycemia
• Monitor blood glucose level post COVID-19 discharge and also in diabetics
• Use steroid judiciously - correct timing, correct dose and duration
• Use clean, sterile water for humidifiers during oxygen therapy
• Use antibiotics/antifungals judiciously

Fatal Black Fungus Infection DON'TS

• Do not miss warning signs and symptoms
• Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
• Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology
• Do not lose crucial time to initiate treatment for mucormycosis

How To Prevent Fatal Black Fungus Infection

• Use masks if you are visiting dusty construction sites
• Wear shoes, long trousers, long sleeve shirts and gloves while handling soil (gardening), moss or manure
• Maintain personal hygiene, including thorough scrub bath

Fatal Black Fungus Infection: When To Suspect

• Sinusitis - nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone One sided facial pain, numbness or swelling
• Blackish discoloration over bridge of nose/palate
• Toothache, loosening of teeth, jaw involvement
• Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
• Chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms

Fatal Black Fungus Infection: How to Manage

• Control diabetes and diabetic ketoacidosis
• Reduce steroids (if patient is still on) with aim to discontinue rapidly
• Discontinue immunomodulating drugs
• No antifungal prophylaxis needed
• Extensive Surgical Debridement - to remove all necrotic materials
  

Fatal Black Fungus Infection: Medical Treatment

• Install peripherally inserted central catheter (PICC line)
• Maintain adequate systemic hydration
• Infuse normal saline IV before Amphotericin B infusion
• Antifungal therapy, for at least 4-6 weeks (follow guidelines)
• Monitor patients clinically and with radio-imaging for response and to detect disease progression