CHENNAI: If you've just recovered from COVID-19 and find your teeth are mobile or eyes red, it will be beneficial to get checked for mucormycosis (black fungus), says Dr Shubhra Chauhan Aranmanai, Consultant Head and Neck Oncosurgeon at VS Hospital, Kilpauk and Billroth Hospital.
"The name 'black fungus' is a misnomer. The fungus is not black in colour. It is the bone impacted by the fungus that turns black or dies and needs to be removed before the fungus spreads beyond or to other parts of the body," says Dr Shubhra, who has operated upon three to four patients in Chennai recently.
Black fungus was not that prevalent during the first wave of the pandemic. The cases became prominent just when the second wave was gaining ground, says Dr Shubhra, who is also heading the Oral Oncology department in the Meenakshi Ammal Dental College and Hospital.
Uncontrolled diabetes, use of broad spectrum antibiotics, use of steroids and increased use of zinc supplements during the pandemic can result in a person suffering from the disease. She says black fungus or mucormycosis is not a new disease. "It was first described in 1885. It is an aggressive, uncommon infection caused by a saprophytic fungus family called Mucorales. It is spread by inhalation, ingestion of contaminated food or any injury caused by an instrument contaminated by the fungus," she says.
The cases in the state went up two months ago when the second wave of the pandemic started. Most of those affected by black fungus are post-COVID patients, which is a worrying sign, says Dr Shubhra.
Initially, the first patient on whom Dr Shubhra performed surgery was an asymptomatic COVID patient who came with mobile teeth. "I had a doubt and asked the patient to undergo a test. He turned out to have COVID positive antibodies and had black fungus in the upper jaw bone," says the doctor. She says black fungus has a high spreading potential and if not treated in time can be fatal.
She says it can be found in the lungs, jaw bone, eye, nose, brain, skin or sometimes stomach. The patient should be alert if he has a mobile teeth, gum abscess, bone exposure especially in the upper jaw or black colour bone. The other symptoms include discharge from nose, stuffiness in nose, cold, numbness over cheeks and headache besides redness, swelling and watery eyes.
Dr Shubhra says the rise of the disease is due to reduced immunity in active and recovered COVID patients, uncontrolled diabetes, high use of steroids and increased use of antibiotics. "Once the patient visits the doctor with any of the symptoms, a clinical examination is required, including nasal endoscopy. If mucormycosis is suspected, the tissue or bone is sent for biopsy and fungal culture & sensitivity to confirm the diagnosis. CT scan or MRI scan is also required after confirming the diagnosis," she says.
She says to treat the disease, an interdisciplinary team approach is required depending on the part which is infected. It could be either head and neck surgeon, ENT surgeon, maxillofacial surgeon, opthalmologist or neurosurgeon and infectious disease specialist
In most cases, surgery is required by removal of the infected bone before the fungus could damage other parts along with antifungal medications. "The mortality rate is high once it reaches the brain. Early detection is important," says the head and neck oncosurgeon.
She says that medicines alone are unable to cure black fungus as they won't be able to reach the infected part. Since the bone involved is necrotic or dead with no blood vessels, the medicines administered will only reach the periphery of the lesion. Hence surgery is an integral part of the treatment, she says.
Dr Shubhra says this infection is an emergency and needs early assessment and treatment. Though the cases in Tamil Nadu are high, currently there is a low official count as it has become a notified disease only recently, she adds.