Black Fungus: New epidemic in a Covid pandemic
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Black Fungus: New epidemic in a Covid pandemic

Along with the Covid-19 pandemic there is now an epidemic of Mucormycosis or ‘Black Fungus' among coronavirus patients. This is a rare fungal infection that has previously been seen in immune-compromised patients like solid organ transplants, hematologi

Post by on Monday, May 24, 2021

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Along with the Covid-19 pandemic there is now an epidemic of Mucormycosis or ‘Black Fungus' among coronavirus patients. This is a rare fungal infection that has previously been seen in immune-compromised patients like solid organ transplants, hematological malignancies and patients on steroid therapy.

With the advent of Covid and aggressive steroid therapy there has been a rapid increase in the number of cases.  The mortality rate of this rare disease is reported to be high (50percent)

 

Areas reporting cases of rare disease

As per a research paper on Black Fungus by NCBI, though cases have been common in China and India, a review indicated that the “disease burden is higher in Europe than in Asia. As many as 34 per cent of the cases were reported from Europe, followed by Asia (31 per cent) and North or South America (28 per cent), Africa (3 percent), Australia and New Zealand (3 percent).”

 The paper also suspected that there might be cases of under-reporting in India and China.

 

Estimated rise of 'Black Fungus' before pandemic

 

A recent study cited in the March 2019 NCBI research paper said, "India reported a rise of Mucormycosis cases from 24.7 cases per year (1990-2007) to 89 cases per year (2013-2015) at a single tertiary-care hospital”. India accounts for 71percent of all cases of 'Black Fungus'

In India at least 7,250 people are confirmed to have Mucormycosis in but the actual spread may be much wider

 

Here are some FAQs about 'Black Fungus'

 

What is 'Black Fungus?

 

 'Black Fungus' or Mucormycosis is a fungal infection that mainly affects people who are on medication for other health problems that reduce their ability to fight environmental pathogens. This rare disease affects the sinuses and lungs of the individual who inhales fungal spores.

 

What are the common symptoms?

The most common symptoms of 'Black Fungus' are pain and redness around eyes and/or nose, fever, headache, coughing, shortness of breath, vomiting blood and disillusion.

 

 Why is it called Black Fungus?

Mucormycosis is called black fungus because it devitalizes affected tissues, turning them black. ‘’This fungus invades the blood vessels stopping blood flow to vital areas and causing tissues to necrose or rot, turning them black.”

 

 Fungus itself is not black

Black fungus is a misnomer. Black fungus technically refers to melanin-producing fungi and not Mucormycosis.

So don't try to look for black spots in and around your mouth in search of black fungus.

 

 What is White Fungus?

Candidida is called White fungus because it causes White Curd lesion like lesions in mouth, throat, genitalia etc

 

 Black fungus--Is it same as found on bread in homes?

No, Fungus found on bread in humid hot climates is Rhizopus, though Mucor and Rhizopus belong to the same family.

 

 Does it spread from person to person?

No, Mucormycosis is not communicable, meaning it does not spread from one person to another. Mucor is a fungus which is present in the environment. One gets the spores from the environment. However, these spores are not able to cause infection because of good immunity but in immune-compromised hosts with high sugar levels these spores are able to germinate and spread.

 

 Are oxygen humidifiers responsible for the outbreak?

Hot and humid climate is one of the reasons to develop this infection. Also Infections are also more common in coastal regions.

This has led to wide speculation that the use of oxygen humidifiers and oxygen delivery masks may be contributing to the outburst, but they are not proven and just remain theories.

 

Humidified oxygen is vital respiratory mucosa. It is a proven therapy for decades without any evidence of superinfection. Dry oxygen on the contrary increases the chances of secondary infection in dried parchment like respiratory epitheluim.

 

 How to improve the hygiene in humidification?

 Use disposal tubing for nasal oxygen supply. Use sterile water in Humidifier water bottle.

 

 Is there any role of using Methylene Blue in a humidifier bottle to prevent mucormycosis?

 Methylene blue has been found effective against white fungus (Candida Albicans) and not against Mucormycosis (except in occasional case reports).

Its use is purely a major that could be called abundance of caution.

 

 Is use of Industrial oxygen responsible for spurt in cases of Mucormycosis?

Oxygen anywhere in the world is manufactured and tapped from Air. Normal airspace has 78 percent nitrogen, 21 percent oxygen and 1 percent other gases.

Medical oxygen is high purity (~99percent) oxygen.

Oil-free compressors are used to produce medical oxygen to avoid risk of contamination.

Though Industrial oxygen purity levels (~95percent) may not be advocated for humans during normal times, there is no evidence that little gas impurities in industrial oxygen are the causes of rise in cases of Mucormycosis. So called impurities in industrial oxygen are after all simple gases found in air which are inhaled by one and all.

Also, in the current scenario it would just not be possible to ramp up production of medical oxygen to fulfill the rising demand. More lives may be lost than saved.

 

Is Oxygen Concentrator better than Industrial Oxygen to prevent Mucormycosis?

An oxygen concentrator is a medical device that takes in air, filters it through a sieve, releases the nitrogen back into the air, and works on the remaining oxygen. Thus the device concentrates oxygen from surrounding air. Device supplies nearly 90percentoxygen at low rates of 3 to 5 litres per minute.

Concentrator is not being useful in patients with high oxygen demand in hospital settings.

If at all any lower incidence of Mucor is seen with use of oxygen concentrators it can be attributed to home bound treatment of relatively less serious patients.

 

 Should patients in Home isolation worry about Mucormycosis?

It is mostly a hospital acquired infection seen in immune-compromised sick patients with very high sugar levels. In one study ~60percent, of hospital beds and pillows, curtains were found to have mucor spores.

There are very few chances of catching Mucormycosis in home isolation in relatively mild to moderate cases. But it is always good to use steroids judiciously and keep sugar in control.

So to sum up there should be judicious use of steroids along with close monitoring and good blood sugar control. Aggressive investigations should be done at the earliest and prompt initiation of medical therapy along with antifungal therapy under expert supervision.

 

 

For more information please subscribe to my Youtube channel “TheKidney Klinic” or visit my website www.kidneyklinic.com.

 Dr Sanjeev Gulati

Chairman Fortis Institute of Renal Sciences & Transplantation

New Delhi


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