Mucormycosis (black fungus) in covid19 patients

Mucormycosis also know as black fungus is an infection caused by mucor mould called mucormycetes that is commonly found in plant manure,soil,decaying fruits and vegetables. It is found in air,soil and even present in the nose and mucus of healthy individual. It can be life threatening for diabetic patients or severley immunocompromised people such as HIV/AIDS or cancer patients. Sinuses,the lungs,brain of these individuals get affected after fungal spores are inhaled from the air

Predisposing factors.

           • Uncontrolled diabetes mellitus 

           • Immunosuppression by steroids 

           • Prolonged ICU stay 

           • Comorbidities- post transplant / malignancy 

           • Voriconazole therapy 

Black fungus and Covid 

     Covid-19 virus causes inflammation in the lungs and reduces oxygen transfer. the inflammation is a consequence of the body's immune system trying to fight the virus hard. Since excessive inflammation cause great harm doctors prefer to suppress the hyper-immune reaction and thus the inflammation. This is done by giving steroids. But the unfortunate and expected outcome of this approach is impaired immunity in covid patients. 

 Mucormycosis in covid patients are of two types:

     • Rhino - orbito - cerebral (Roc-MM)

              

    As the name implies the nose,eyes and skull area are severely affected .

       

      • Pulmonary (P-MM)

     As the name implies the lungs are severely affected. 

Symptoms: 

  1.Rhini - orbito - cerebral (MM)

           • congestion or blockage of the nose.

           • dark red or black discharge from the nose.

           • numbness, swelling or pain in the eyes

           • facial pain,headache,tooth ache,jaw pain .

           • blurred vision, double vision.

           • fever ,black lesions on the skin especially on the nose.

           

 2. Pulmonary (MM)   

           • cough blood in sputum.

           • chest pain.

           • plural effusion .

           • fever and haemoptysis.

           • worsening of respiratory symptoms 

Do's

          • Control hyperglycemia

          • Monitor blood glucose level post COVID-19 discharge and also in diabetics

          • Use steroid judiciously – correct timing, correct dose and duration

          • Use clean, sterile water for humidifiers during oxygen therapy 

Management:

           • Control diabetes and diabetic ketoacidosis.

           • Reduce steroids (if patient is still on) with aim to discontinue rapidly.

            • Discontinue immunomodulating drugs.

            • No antifungal prophylaxis needed

Extensive Surgical Debridement - to remove all necrotic materials.

Medical treatment:

            • Install peripherally inserted central catheter (PICCline).

            • Maintain adequat systemic hydration.

            • Infuse Normal saline IV before Amphotericin B infusion

             • Antifungal Therapy, for at least 4-6 weeks .

             • Monitor patients clinically and with radio-imaging for response and to detect disease progression.

 Precautions       

  • wash hands often .

• Wear a mask so that you do not end up inhaling the fungal spores.
• Keep your home sufficiently ventilated.
• Avoid picking your nose.
• Do not rub your eyes.
• Do not scratch your skin.
• For COVID patients, one way to stop the possibility of fungal infection is to ensure that patients (both in treatment and after the recovery) are administered the right dose and duration of steroids only under medical supervision.