Black fungus/Mucor mycosis

Black fungus/Mucor mycosis

20 May 2021

Black fungus / Mucor mycosis

Mucor mycosis is an infection caused by fungi which predominantly affects Nose ,eyes and brain and hence it is called Rhino orbito cerebral Mucor mycosis.

 Is it newly discovered fugus?

No , ENT surgeons and Ophthalmologist have been treating this condition since many  years. But in second wave of covid incidences have gone very high.

Is the fungus Black?

Black fungus is misnomer. Fungus is not black. But fungus invades through small blood vessels blocking it and making tissue dead and forming clots ( micro Angio invasive) giving a black appearance .

 Who are susceptible  to get this infection ?

 It is the immunocompromised status of the patient which allows the mucor to invade in to the nasal mucosa. Most common immune compromised status would be uncontrolled diabetes, patient on high dose of steroids , renal transplant patients or if you are on any immune suppressive medications. It is also found  during second wave that patient who received long term oxygen therapy / ICU admission could also be susceptible candidates.

 What are the warning signs of possible Mucor infection?

Unfortunately early signs could be as vague as just nasal blockage. But as the disease progresses patient c/o intense facial pain  , facial numbness, crusting or dryness inside the nose  and  also there could be blurring of vision and bulging of eye. On examination there could black patches or crusts inside nasal cavity , palatal perforation.  If these symptoms occur in the background of uncontrolled diabetics who was on steroid treatment and in covid recovered patient oneshould have high index of suspicion for Mucor mycosis.

 Can Mucor mycosis spread from person to person?

Mucor is ubiquitous fungi. That means that it is there in the soil, dead and decaying substance, contaminated water. We tend to inhale these spores on daily  basis. But our immunity system prevents it from invading. So, only in immunocopmramised patient these fungal spores causes problem.

 What are treatment options for mucor?

Mucor mycosis is a disease with high mortality. So early detection  is important to prevent progression in to eyes and brain. Early endoscopy and radiologic investigations are important. Surgical debridement of fungus with administration of Anti fungal agents as Amphotericin B for a period of 4-6 weeks becomes main stay of treatment.

 Should one be worried of steroid nasal sprays and inhaled corticosteroids too?

In intra nasal  corticosteroids used in Allergic Rhinitis and Inhaled corticosteroids which are being used in Asthma , steroids are in extremely small dose  as in micrograms. More so they act predominantly topically only in nose and  lungs and their systemic absorptionin to blood stream is negligible. Asthmatics and Allergic Rhinitis patients who have suffered from covid in recent time need not stop their topical  steroid therapy.