Alertness and precautions can overcome black fungi menace; expert

Mohali: “With having 2nd largest diabetic population globally and nearly 70% of these cases being those of uncontrolled diabetes, India has a strong risk factor for mucormycosis or black fungi.”

Dr Navdeep Kaur Boparai, ENT expert in Ivy Hospital, Mohali said on Thursday that second Covid wave has been worse than the first and has led to the increase in usage of steroid, which not only worsens the sugar control but also increases the risk of developing mucormycosis.

She said further that most of the hospitalized patients require oxygen and contaminated cylinders, humidifiers, steamers which are becoming a potential source for mucor infection.

Poor oro-nasal hygiene in hospitalized patients and use of the same mask for prolonged periods is also becoming a cause for mucormycosis. The major route of infection is via inhalation of conidia and other routes include ingestion and traumatic, she informed.

“When spores are deposited in the nasal turbinate the rhino cerebral disease develops. When spores are inhaled into the lungs the pulmonary disease develops, when ingested the GI disease ensues, and when these agents are introduced through interrupted skin, cutaneous disease develops.”

Dr Navdeep said that infection spreads along vascular and neuronal structures & infiltrates into the walls of blood vessels. It can erode bone through walls of the sinus and can spread into the orbit and the retro-orbital area, thereby extending into the brain.

We are witnessing patients with foul smelling nasal discharge, nasal stuffiness,  nasal bleed, nasal hypoesthesia, headache , nausea ,  fever and  lethargy ,she pointed out.  

All cases of post Covid-19 infection with such symptoms should be subjected to imaging to confirm sinus involvement and beyond, she opined.

She said symptoms of pulmonary (lung) mucormycosis include:  fever, cough, chest pain & shortness of breath. The symptoms of gastrointestinal mucormycosis include; abdominal pain, nausea and vomiting and gastrointestinal bleeding.

Disseminated mucormycosis typically occurs in people who are already sick from other medical conditions, so it can be difficult to know which symptoms are related to mucormycosis, she asserted.

Mucormycosis is clinically fatal as no survivors of mucormycosis were reported before 1955. A review of published mucormycosis cases found an overall mortality rate of 54%. The mortality rate was 46% among people with sinus infections, 76% for pulmonary infections, and 96% for disseminated mucormycosis, she informed.  

The prognosis of mucormycosis may improve with rapid diagnosis, early management, including combined antifungal drugs ,  aggressive surgical interventions and reversal of underlying risk factors, she said.  

Thus one should visit the nearest ENT specialist for nasal endoscopic evaluation in case of any doubt to avoid developing any life threatening complication. Let us all fight this Covid pandemic and the menace of mucormycosis collectively by being alert and taking proper precautions, Dr Navdeep remarked.