Black Fungus Mucormycosis - COVID HELPLINE BANGALORE

Black Fungus
Mucormycosis

What is Mucormycosis ?
• Mucormycosis is a fungal infection mainly
  affecting people with medical health problems .
• Mucormycosis also called Black Fungus due to
  black lesions it forms in the infected area.
• Lower Immunity leads to this

Mucormycosis
• Fungus eats /lives on Sugar → So very common in Diabetics
• Diabetes has high Sugar
• Steroid increase Sugars in blood
• Generally deep seated, making early diagnosis difficult
• Angio- invasive infection – Infiltrates blood vessels

• Aggressive opportunistic
• Thermotolerant: Heat Tolerant
• Infects deeper tissues - Sinus , Eye, Bone to Brain
• Very serious as it spreads very rapidly
• Eye Pain to Permanent loss of vision very fast
• Could be Fatal / Deadly
• Found
   ✓ In Soil, Air, decaying organic matter as leaves, rotten wood
   ✓ After someone breathes in spores
   ✓ Enters through skin cut, scrape, burn, trauma

Complications
• Blindness
• Organ dysfunction

Prognosis
• It is a life-threatening infection depending on patient
  condition, type of fungus, and body site affected

How does someone gets it?

• Inhalation - Through contact with fungal
  spores in the environment
• Inoculation - Fungus enters skin scrape,
  burn, or other injury
• Ingestion

Who gets Black Fungus?
• Weakening of immune system due to use of steroids
• Immunosuppression
• Uncontrolled diabetes
• Iron overload frequent blood transfusions
• Blood disorders Neutropenia
• Prolonged ICU/hospital stay
• Cancer/ Organ transplant
• Skin injury

Mucormycosis in COVID-19
 Black Fungus is on the rise in India, mainly due to the COVID19 infection.
 On average there are around 14 cases per 1,00,000 population in India.
 Most patients contracted it between 12 to 15 days after recovery from Covid-19.

So Why is Black Fungus more common in COVID19 patients ?
 Due to
 • Un-controlled Sugars
 • Indiscriminate steroid usage
 • Use of Non sterile water in Humidifier in Oxygen Concentrator/Cylinders
 • Immunocompromised – Kidney failure, Organ Transplant

Types
• Rhinocerebral - Nose, Brain
• Pulmonary - Lungs
• Cutaneous - Skin
• Gastrointestinal - Stomach
• Disseminated - Everywhere
• Uncommon presentations

Types & Symptoms
Rhinocerebral
                                                      Pulmonary
• Local pain on cheek bone, one-sided facial pain,
  numbness or swelling                                • Fever
• Blackish discoloration over bridge of nose/palate   • Cough
• Loosening of teeth, jaw involvement                 • Chest pain
• Black pus from eyes                                 • Dyspnea
• Blurred or double vision with pain
• Nasal or sinus congestion or pain or discharge
• Fever, Headaches

Types & Symptoms
Cutaneous                       Gastrointestinal
• Local skin trauma
                                • Ingestion of organism
• Pus, Abscess
                                • Abdominal pain
• Swelling
                                • Nausea
• Skin appear red
                                • Vomiting
• Ulcer covered black eschars

Is it contagious?

• No.
• It doesn’t spread between people

How to avoid it ?
Do's                              Don'ts
• Control Diabetes                • Do not miss warning signs

• Monitor blood sugar level       • Do not ignore blocked nose/ Sinusitis

• Use steroid/                    • Do not hesitate to seek help
  antibiotics/antifungals         • Do not lose crucial time to start
  judiciously                       treatment
• If using oxygen therapy,        • Don’t skip monitoring blood sugar
  use sterile / distilled water     even weeks or months after COVID19
  for humidifiers (oxygen           recovery
  concentrators/cylinders)

How to Prevent Mucormycosis?
                   • Tight control of Diabetes
                   • Reduce steroids when possible
• Wear a N95 respirator
• Avoid direct contact with water-damaged buildings & flood water areas
• Avoid activities involving contact to soil or dust as gardening
• Wear gloves when handling materials such as soil, moss
• Clean skin injuries well with soap and water, especially if contaminated

Treatment
                          ✓ Rapid diagnosis
                      ✓ Reversal of predisposition
                     ✓ Urgent surgical debridement

• If not diagnosed early and aggressively treated, it is almost always fatal
• Antifungal - Amphotericin B, Posaconazole, Or Isavuconazole
• Surgical resection of infected tissue necessary for Rhinocerebral,
  Cutaneous, and Gastrointestinal infections
• Retro-orbital space → Eye Spread →Enucleation

In Laboratory     In Clinic
    How does it look ?

How does it look ?

Thank you !