Mucomycosis

                                            Mucormycosis

(Deadly Fungal Infection)

(Battling a new epidemic)

A mucormycosis infection is often called “black fungus” since it causes blackening or discoloration over the nose.

India's endemic health care issues have now led to a rise in black fungus cases.

Health experts have claimed that 'misuse of steroids'  during Covid treatment is the major cause of black fungus infection or mucormycosis. Also, diabetic people are more prone to this rare fungal infection. Mucomycosis are occurring in people who have high blood sugar and have been given strong doses of steroids or immuno-suppressants to calm an immune system. kicked into overdrive by Covid-19 for more than 12 months.now. Doctors know how to choreograph an immune response so that a patient is not unnecessarily vulnerable while stopping immune cells known as cytokines from destroying tissues in the lungs and elsewhere.

People have been self medicating with steroids, which are cheap and are seen as lifesavers in Covid 19. India has a large number of people with uncontrolled diabetes.

India's medical facilities, particularly in smaller towns and villages, lack adequate hygiene.(structural problem)

These organisms are typically in abundance in a country like India and particularly in soil and decaying organic material such as fruit and vegetables but a normally functioning immune system typically fights it off.

"Mucormycosis occur only when immunity is critically low."

What I mucormycosis?

It is an aggressive and invasive fungal infection that can affect various vital organs such as the brain and cause internal damage to the ear,nose,throat and mouth. It is not contagious, but can be fatal if not detected early.

Prevalence

It is a serious but rare disease. A prevalence of 0.14 cases per 1,000 individuals in India.

The Organism

Black Fungus

'Infection affects only those who have high blood sugar levels.'

Mucormycosis or black fungus (previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds live throughout the environment. Mucormycosis mainly affects people who have health problems or take medicines that lower the body's ability to fight germs and sickness.

Mucormycosis has been observed in a number of Covid 19 patients recently. A fungal infection mainly affecting people with medical health problems that reduce their ability to fight environmental pathogen.

The fungus that causes the disease is found in soil and decaying organic matter such as fruit and vegetables, and is as ubiquitous in the natural environment as the immunity to it among healthy people. These are spread over a wide spectrum of issues involving hygiene, a lack of understanding of best practices, a tendency to self medicate and even misinformation.

It can enter the body  through breathing or skin Injuries.

'Infection affects only those who have high blood sugar levels.'

How Does Patient Get Predisposed to mucormycosis?

• Uncontrolled Diabetes as fungus feeds on sugar,
• Steroid Therapy for long period or heavy steroid treatment in Covid 19.
• Patient kept on humidified oxygen
• Prolonged I C U Stay
• Bone Marrow Post transplant recipient
• Malignancy
• H I V
• Neutropenic Patients
• Malnourished individuals specially Children
• Persons in renal failure
• Intravenous drug abusers (at risk of cerebral mucormycosis)
• Desferroxamine therapy and all causes of iron overload.

Symptoms

Nose & Sinuses mucor infection (relatively early disease)

• Mucor infection generally starts in the nose and may progress to the eye and the brain.
• Nasal and sinus congestion
• Headache and nasal obstruction persistent or severe, not responding to pain Medicines.
• Pain or loss of sensation on face.
• Discoloration of skin of face, / localized facial puffiness.
• Loosening of teeth, / discoloration or ulceration of palate.
• Eye / Orbital mucor infection (moderately advanced disease)
• Eye swelling or redness, double vision or loss of vision, eye pain or drooping of eyelids.
• Black lesion on upper inside of mouth
• Fatigue,tiredness, breathlessness, loss of energy , reduces, appetite.
• It is often accompanied with blurred or double vision, chest pain, breathing difficulties and coughing blood as it can infect sinus cavities  and can even go up to the brain.
• Facial Deformity
• Facial pain
• Nasal congestion
• Loss of vision or pain in eyes
• Altered mental state, confusion
• Swelling in cheeks and eyes
• Toothache, loosening of teeth
• Black crusts in the nose. (Don't ignore black lesion)

• 

"According to the U S Centers for disease control, mucormycosis has the disease fatality rate around 54% which tends to be higher if someone has a respiratory illness." 

                       

What to do if you have these symptoms?

• Consult your doctor immediately.
• Doctor will examine you clinically. If required the doctor will take swabs from the nose and test them for fungus.
• If infection is strongly suspected or confirmed, treatment with anti fungal medication and surgery might be needed.

Types

Pulmonary Mucomycosis

Orbital Mucomycosis

Infection with mucormycosis can cause loss of eye and may be life threatening.

Cutenous Mucormycosis

Cerebral Mucormycosis

Black fungus in Sinuses

Mucor infection may occur during Covid 19 infection or a few weeks after the recovery from Covid 19.

."Maintaining good hygiene to stay protected from black fungus infection. Taking bath daily and doing gargles are very effective. Nasal and oral care is very important."

Cause Of Surge

• Covid 19 might worsen Diabetes or cause diabetes in previously normal individuals.
• Covid 19 medicines like steroid & Tocilizumab can worsen immune status , hence to be taken only on doctors advice.
• The severity of mucor infection largely dependent upon patients immunity and general health.

Prevention

Precaution : Not to prescribe immune suppressing steroids too early, and for more attention to be given to people with high blood sugar that makes them vulnerable to opportunistic pathogens.

• Keep blood sugar under check Covid or no Covid.
• Use steroid judiciously while treating Covid.
• Use clean water in humidifier used for oxygen support.
• Maintain overall cleanliness around the patient.
• Any oral ulcer should be treated immediately.
• Need for citizens to go by proper medical advice, and for the the government to make it available.
• It also brings into focus the lack of proper checks on drugs sales.
• Avoid over use of antibiotics.

"Diabetes are more prone to getting black fungus infection. They need to maintain their sugar levels and take care of the cleanliness around them. Even if one  have recovered from Covid, it is important to wear masks so that the infection doesn't enter the body. "

Do's

• Self medicate especially steroids.
• Delay reporting Symptoms of mucor.
• Ignore medical advice.

Don't

• Give history of diabetes to doctor.
• Get sugar level checked.
• Watch for early signs of mucor listed above.
• Maintain basic hygiene & cleanliness.

Treatment

• The main line of treatment is an anti-fungal drug called Amphotericin B, which is given over an extended period of time under strict observation.

• Other anti-fungal drugs used are,Posaconazole,I savuconazole.

• Surgery might also be warranted.If it has spread Significantly mucormycosis requires surgery to cut away the infected Tissue- A process known as Debridement. Some cases require removal of the eyes or large part of tissue.

Caution

• Diabetics should be extra cautious and bring sugar under control.
• Doctor should avoid rampant use of steroids unless deemed life saving in Covid.

Prevention

It is been observed that mucormycosis is on the rise in post Covid patients. Recently two 25-30 age group patient with history of covid treated by home isolation no history of taken steroid or given oxygen or did not have diabetes also suddenly developed this dreadful disease. 
The question how and where did it come from ?
Once you get a viral infection your immunity goes down .Try to increase your immunity.
We have been wearing a mask, it may be N 95 or a cotton mask,  which is used multiple times.  Once we wear it, due to the humidity in our breathing, it gets wet which we don't feel.  Then the mask is being used for 3-5 days, a perfect atmosphere for growth of fungus, which we breathe.  So all citizens whatever you have been using as a mask please wash it daily or change it or Iron (प्रेस) it before use after washing or reuse, dry it in pure sun light so no fungus grows on it.
While washing mask a bit of white vinegar along with lemon salt would also take care of fungus and it’s musty smell.....

Filters of A Cs were found to harbor moulds of fungus that too in rainy season, regular cleaning is needed.
Be careful

Summery

• The spike at present appears to be a fall out  of incorrect Covid 19 treatment for use of some drugs.

• Cheap steroid medication used to calm an exaggerated inflammatory response to the Corona virus appears to be the prime trigger, with high prevalence of Diabetes making it worse.

• According to ICMR the fungus thrives on high sugar making Covid 19 patients with uncontrolled diabetes particularly vulnerable.

• Inadequate infection control in  hospital also  risk exposing Covid patients to  secondary bacterial & fungal infections.

Both the pandemic and now the epidemic, have shown the acute harm caused by endemic problems. Don't let this persist.

https://madhuchhandacdmo.blogspot.com/2021/05/mucomycosis.html