Mucormycosis or Black Fungus & COVID-19 

So many people are suffering from COVID-19 all over the globe. But in post-COVID-19 patients, the rare but critical fungal infection is seen called mucormycosis.

Mucormycosis was previously known as zygomycosis also it is called a black fungus. We all know that there are so many conditions in which fungal infection is common in humans also. Mucormycosis is one of rare and serious fungal infection which can lead to serious health issues is seen nowadays in COVID-19 patient.

List of topics in the article

• Black fungal disease in India
• What is a black fungus or mucormycosis
• Types of mucor micosis
• Symptoms of black fungus
• Risk factors for black fungus
• Post COIVD-19 mucormicosis or black fungus
• Symptoms of Post COVID-19 mucormycosis or Black Fungus
• Treatment of post-COVID-19 mucormycosis or Black Fungus
• Can Black fungus occur after vaccination?
• A person who had mild COVID 19 and would have recovered in-home quarantine will be affected by black fungus?
• How can black fungus affect non-diabetic patients?

Black Fungal disease in India

Black fungus is rare but in India, so many people are diabetic and pre-diabetic, this condition develops in people with high sugar levels in the blood. Also due to ventilator support and oxygen, there is increase humidity around the nasal area of the face this makes a more preferable condition for the growth of black fungus and leads to an increase in black fungus cases in India.

What is mucormycosis or Black Fungus?

Types of mucormycosis  

There are mainly several types of mucormycosis is available throughout the world. The types of mucormycosis are based on the part or system which is affected in the body, These includes;

• Rhinocerebral  mucormycosis (sinus and brain)
• Pulmonary mucormycosis (lung)
• Gastrointestinal mucormycosis
• Cutaneous mucormycosis(skin)
• Disseminated mucormycosis

Rhinocerebral mucormycosis:- 

This type of mucormycosis affects the sinuses and brain of your body, It can lead to serious medical illness to the patient. The infection first occurs inside or outside the nasal cavity or in the sinuses of the face. Then it spread through sinuses to the brain and affects brain function.

• People with uncontrolled diabetes
• A person who had done a kidney transplant 

Are more prone to Rhinocerebral mucormycosis.

Symptoms of Rhinocerebral mucormycosis

Pulmonary mucormycosis:-

Pulmonary mucormycosis mainly affects the lung of the patient and causes a disturbance in the function of the respiratory system. This is one of the most common types of mucormycosis, it can be seen in;

• People with an organ transplant or
• Stem cell transplant
• Person with cancer

Symptoms of Pulmonary mucormycosis

Symptoms of pulmonary mucormycosis include;

Gastrointestinal mucormycosis:-

It is also a common type of mucormycosis. As the name suggests it affects the gastrointestinal system of the body. It is more seen in children in comparison to adults, mostly seen in premature babies as well as babies with low birth weight in less than 1 month of age with surgery, antibiotics, or medication.

Symptoms of Gastrointestinal mucormycosis

Cutaneous mucormycosis:-

It affects the cutaneous tissue of the body or we can say on the skin. It causes the fungi to enter the skin through the wound or breakdown of skin integrity due to any kind of surgery, trauma, etc. 

It is the most common type of mucormycosis developed in people with poor immune systems.

Symptoms of Cutaneous mucormycosis

Disseminated mucormycosis:-

This occurs due to the spread of infection occurs through the bloodstream in the various parts of the body. When a person has developed mucormycosis and in any part of the body then it spread through the bloodstream it is called disseminated mucormycosis.

We all know that blood circulated throughout the body, and this type of mucormycosis mainly affects the brain as well as other important organs like the spleen, heart, etc.

Symptoms of disseminated mucormycosis are difficult to rule out as it is secondary to the medical condition many times.

It mainly affects the brain and organs like the heart and spleen thus the mental symptoms and abdominal or respiratory symptoms may be developed.

Risk factors of mucormycosis  or black fungus

 There are so many conditions after the mucormycosis can occur. Many times the mucormycosis is secondary, the conditions after mucormycosis can develop include;

• Diabetes, especially with diabetic ketoacidosis
• Cancer
• Organ transplant
• Stem cell transplant
• Neutropenia (low number of white blood cells)
• Long-term corticosteroid use
• Injection drug use
• Too much iron in the body (iron overload or hemochromatosis)
• Skin injury due to surgery, burns, or wounds
• Prematurity and low birthweight (for neonatal gastrointestinal mucormycosis)

Recently the cases of mucormycosis are more likely to increase in the patient with COVID-19. People with uncontrolled diabetes are more prone to have mucormycosis.

 Post COVID-19 mucormycosis Or Black Fungus

Mucormycosis generally seems because of the diabetes-defining sickness and remains one of all the foremost devastating complications in uncontrolled diabetics with mortality rates go between 40-80%. Asian country contributes to four-hundredth of the world’s burden of this “rare mold” infection because it is termed in western literature, with associate degree calculable prevalence of a hundred and forty cases per million population.

There is post COVID-19 sepsis occurs, this condition leads to the reduce immune responses as well as following things

• Dysfunction of cilia
• Cytokine Strom 
• Coagulation in microvasculature or small vessels 

This leads to exhaustion of the immune system, which further results in secondary fungal infection to the patient. A patient who comes to the emergency in which the invasive treatment is needed is likely more prone to Post COVID-19 mucormycosis.

• Mechanical ventilation
• CRRT ( continuous renal replacement therapy)
• ECMO ( extracorporeal membrane oxygenation) 
• Poor nursing ratios
• Prolong hospitalization and
• Breaches in asepsis 

This can also lead to result in secondary fungal infection of mucormycosis. Also the usage of corticosteroid during treatment and anti-IL-6-directed strategies in highly susceptible hosts along with high fungal spore counts in the environment lead to the ideal situation for mold infections.

Also, the fungi can be found throughout the environment and humid Indian environmental condition is perfect for the organism to produce infection in the patient. 

That is why mucormycosis is one of the life-threatening post-COVID-19 complications, especially in patients with hyperglycemia and other conditions.

There are mainly two types of mucormycosis that occurs in post-COVID-19 complication, which are;

• Rhinocerebral mucormycosis
• Pulmonary mucormycosis

The strongest predisposing issue seems to be hyperglycemia in unknown or uncontrolled diabetics. hyperglycemia results in enhanced expression of the epithelium receptor GRP78, leading to

• Polymorphonuclear pathology, 
• Impaired chemotaxis and defective intracellular killing.

A very important virulence attribute of fungus order is that the ability to accumulate iron from the host that is a vital part of its growth.

In conditions of acidosis, free iron becomes without delay accessible within the body fluid. This excess endogenous iron is with efficiency preoccupied with the fungus order through siderophores or iron permeases, more enhancing their virulence. 

These effects are greatly amplified by the utilization of corticosteroids and immunosuppressants in prone hosts. Corticosteroids themselves cause impairment within the leukocyte migration, ingestion, and phagolysosome fusion. 

In addition to the potential implications of steroid-induced hyperglycemia, the diabetic COVID-19 patient receiving corticosteroids or alternative immunosuppressants are exceptionally prone to the event of mucormycosis.

Symptoms of Post COVID-19 mucormycosis or Black Fungus

• Black colored discharge from the nasal or oral cavity with necrotic lesion
• Rapid progression in infection
• Facial swelling
• Fever
• Headache
• Some time involvement of nerve includes 

1. Orbital,
2. Ocular,
3. Cranial

The involvement of nerves should be taken seriously as it may become life-threatening to the patient. And in this condition, the use of steroids may lead to some serious illness.

Diagnosis of post-COVID-19 mucormycosis or Black Fungus

There are several diagnostic methods present for a diagnosis of mucormycosis, but for the post-COVID-19 mucormycosis or Black Fungus the rapid diagnostic test includes;

• Biopsy
• KOH mount and
• Calcofluor stain

Treatment of post-COVID-19 mucormycosis or Black Fungus

Treatment should be started as soon as possible after the diagnosis of post-COVID-19 mucormycosis or Black Fungus. Principal of treatment includes;

• Antifungal agents
• Surgical debridement 
• Removal of predisposing factors
• Amphotericin B is used for invasive mucormycosis
• Adjuvant therapy.

Can Black fungus occur after vaccination?

It can occur after vaccination if it gets preferable environmental conditions around you and chances to become more if you are diabetic or pre-diabetic.

But after vaccination chances of COVIS-19 becomes less so we can say that the chances of black fungus after vaccination also decreased in number.

A person who had mild COVID 19 and would have recovered in-home quarantine will be affected by black fungus?

If you keep clean around yourself and take precautions about black fungus as well as COVID-19 and maintain COVID-appropriate behavior then you do not develop black fungus disease.

All you just need is to take precautions and maintain your self-clean and environment clean.

How can black fungus affect non-diabetic patients?

As we discussed above humidity and low resistance of the body can also result in growth for the black fungus. 

If there is a black fungus-appropriate environment around you and you are sick or your immunity is low or you are immunosuppressed, in these all conditions there are chances that non-diabetic patients may also develop black fungus.

Especially immunosuppressed people have more chances to develop black fungus also if they are non-diabetic.