KOCHI: Though most fungi found on the planet are harmless, some can cause severe diseases in humans, several of which may be fatal if untreated. Around 300 types of fungi are dangerous this way, especially for people with suppressed immunity, including Aspergillus, Candida, Cryptococcus, Histoplasma, Mucor and Pneumocystis.
The so-called dermatophytes and keratinophilic fungi, can attack eyes, nails, hair, and especially the skin, and cause local infections such as ringworm and athlete’s foot. Fungal spores are also a cause of allergies. A species of fungus known as Candida albicans is the reason for an infection known as Candidiasis or thrush, found particularly in individuals with suppressed or low immunity. This fungus infection typically produces white patches over the area it affects. Hence sometimes it is referred to as White Fungus. It can affect the mouth, tongue, skin, nails, hair, food pipe, airway, lungs and vagina.
Who is vulnerable to fungal infections?
People with uncontrolled sugar levels, kidney disorders, those taking steroids, chemotherapy drugs or other immunosuppressive drugs are prone to such infections. Covid can become severe in diabetic patients and those with low immunity and might weaken a person’s immunity. Secondary infections are reported in 30% of shospitalised Covid patients, and fungal infections are 10 times more common.
What is Mucormycosis?
Mucormycosis is caused by fungi that belong to a group known as Mucorales. They can infect the nose, paranasal sinuses and from there they can spread to the eyes, brain, the upper part of the mouth, face, respiratory pathway and reach the lungs. It has also been less commonly reported to affect skin, stomach and intestines. The fungus itself is white but the infected area becomes black because of loss of blood supply to that area, hence the name Black Fungus.
The prevalence of Mucor in the Indian population is 0.14 per 1000, which is about 80 times higher than in developed countries. The fatality rate of Mucormycosis is 46% globally. India has recorded 11,717 cases of Black Fungus so far, amid the second wave of Covid . Around 45 cases were reported in Kerala. The most commonly seen variety of mucormycosis is the one that affects the nose, eye and brain known as Rhino- Orbito-Cerebral Mucormycosis (ROCM). Dr George Kuruvila is the head of ENT department and Dr Tinu is ENT consultant at Lourdes Hospital Kochi.
Treatment
Very strict sugar control is a crucial part of the treatment of Mucormycosis.Tapering and discontinuation of steroids are needed. Discontinuation of other drugs which reduces immunity if possible. Surgical removal of all affected parts and tissue is a crucial part of the treatment. This can include an endoscopic nasal and sinus surgery, removal of the diseased bones which can include the upper part of the mouth, various teeth and cheekbone and removal of the eye. This is done to prevent the further spread of infection. Amphotericin B is the most common antifungal used.
Symptoms
Mucormycosis patients will experience nose block, nasal discharge, blackish discharge or crusts, phlegm mixed with blood from the nose, foul smell, headache, jaw pain, facial pain, numbness of the face, toothache, loosening of teeth, blurring of vision, double vision, eye pain, fever and cough, chest pain and blood mixed with sputum if it affects lungs.
Prevention
As poorly controlled diabetes is the major issue, stringent sugar control is essential. No medications, especially steroids and antibiotics, should be taken without a specialist consultation.
Myths
Mucormycosis is not contagious. It does not spread from one person to another.
Wearing a mask does not cause Mucormycosis, as long as personal hygiene is maintained.
No medications should be started or stopped without consulting the doctor