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

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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.

Representational Image

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

Black fungus warning amid COVID-19 patients gets louderBlack fungus warning amid COVID-19 patients gets louder

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

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