Black Fungus infection in Covid-19 patients

@hina iqbal

It has been more than 17 months since a pandemic took over the world. In the last one and a half years, you have learned a lot of new things about the virus. New symptoms still keep showing up every day. One such symptom is doing grounds in the hospitals these days termed black fungus. It is being heard a lot, especially after the second covered wave. Now, what is black fungus? It is a fungal infection also called Mucormycosis, previously known by the name zygomycosis. It is a bad dreaded fungus and it has a bad outcome unless diagnosed early. What happens is, the spores of the fungus reach the host. More so in patients who are post Covid or during Covid and have diabetes sugar is uncontrolled or are immunocompromised for some other reason. Once they reach the sinuses, they involve the sinuses and the nose and if it is not diagnosed in time and treatment started it can go to the eye and eyeball and also go intracranially and reach the brain.

Now, this is a fungus that has a mortality of about 50 percent even with treatment. So you as patients must understand why this is being caused. This is to inform you that the term black fungus or Mucormycosis is caused by a particular group of fungus which belongs to the family of Auriculariaceae. Normally, these fungi are found in the soil in the dead matter of vegetables or animals which could be something harmless in the soil. They are normally floating around but our human immune system is very capable of fighting these infections. Under normal circumstances, you do not see Mucormycosis infection. However, Covid-19 has been known to attack the immune system of our bodies making it very vulnerable to small infections also. Especially the fact that you are dealing with a lot of people with diabetes a lot of people who are on a significant amount of antiviral drugs and a lot of steroids is further weakening the immune system of your body making it very prone for these pores to invade the system and cause the black fungus infection. 

The cases were there before also it is not something new but the incidence was very low. Mostly in the second wave or some countries in third-wave you are seeing an abnormally high number of patients. The first reason is steroid use. Steroids are required for the treatment of Covid in a correct dose for the correct time there is no doubt about that. However, what is happening is very high doses of steroids are being used for a long time sometimes even without medical supervision. So you, the public, need to be educated that don't take steroids on your own. Secondly, sometimes even tapering of the steroid dose is not being done. Then there are a lot of these patients who are diabetics and uncontrolled diabetes in a setting of Covid is the perfect cocktail for getting a new infection.

What are the symptoms you watch out for? If you have nasal symptoms like nasal discharge which may be bloody and also facial pain numbness on the face and headache. It can also invade the eye. Now the eye part basically can lead to swelling in the eyes, drooping of the eyes, bulging of the eyes lack of movements in the eyes because of the involvement of the muscles and the nerves which are coming to innervate the entire eyeball. So if the entire eyeball is affected, the person is not able to move the eyes up or down right or left causing double vision. All these merit ENT evaluations,  your nose needs to be looked at with the endoscope to see any pallor or blackening in the nose or the palette. In case it is there then you need to act fast and need to start the antifungals. The mainstay of treatment is surgery which maybe if it is confined to the nose may be endoscopic surgery.  Or if it may go to the eyeball then you may at times be able to do eye sparing surgery. Sometimes eye may need to be taken out. So take a short message here be aware of this entity.

Even after Covid don't take it easy. If you are a diabetic get your sugar controlled.  If any of the symptoms mentions appeared get yourself examined. Your doctor may write a CT PNS or MRI of the PNS and then you can diagnose this condition early and if it is diagnosed early then treatment can be a success.