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The second wave of covid-19 is full of shock value, or that’s what we believe. Unlike the last wave, this time around, there are some pronounced complications observed in infected patients, and that’s what’s leaving the world even more worried. But as always, we believe being informed is the key to preventing further issues. That’s exactly why we are here to speak about mucormycosis or black fungus, a rare complication that is wreaking havoc in those who have covid-19.
Before we get down to the details, let’s first understand what this infection really is. According to the Indian Council of Medical Research (ICMR), 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.
Dr Anchal Gupta, senior eye surgeon explains it to us. “Mucormycosis is a ubiquitous fungus, present everywhere in soil and air. It does not affect healthy individuals, only immune-suppressed individuals.
It is marked by pain and redness around eyes or nose, fever, headaches, coughing, shortness of breath, vomiting in blood, and altered mental status. Some of the factors that may lead to black fungus infection include uncontrolled diabetes, immunosuppression by steroids, prolonged stay in the hospital, comorbidities, as well as voriconazole therapy.
In diabetic patients who have covid-19 or those who are on immunosuppressed medications, black fungus presents itself in the form of sinusitis, blackish discolouration over the bridge of the palate or nose, one-sided facial pain, blurred vision, toothache, chest pain and respiratory problems.
Dr Gupta has an answer. “Increasing number of potentially serious covid patients in the second wave with inadvertent use of high doses steroids for longer periods is the biggest reason. Plus, more patients needing oxygenation for a longer time, not maintaining proper hygiene and sanitation of oxygen delivery pipes has led to its spike. In certain cases, industrial oxygen is being used, due to paucity, which is not as sterile as medical grade oxygen. Last but not the least, warm humid weather conditions are more favourable for fungal growth.”
“The fungus is extremely ferocious and every hour counts. In one to three days, the fungus can corrode from the nasal sinuses to the eye and ultimately to the brain, leading to death. Early surgery to debride and debulk the fungus invasion is the only option, once it has entered the sinuses. Very high doses of antifungal injection amphotericin B are also needed,” says Dr Gupta.
There are some ways to reduce its occurrence, according to Dr Gupta. First of all, it is important to practice the judicious use of steroids, only under physician guidance. “Avoid steroids in the first five to seven days of covid symptoms, and do not take steroids for more than a week. Steroids are only to be used only in severe hypoxia (spO2 level less than 94 percent).”
It is also critical to monitor blood sugar levels, especially in diabetic patients on steroids. Special attention must also be given to patients having high serum ferritin during the course of covid.
“Maintaining proper asepsis and hygiene, while on ventilation or oxygen delivery is equally significant. Fungus growth is generally noted in pipes connecting the humidifier,” adds Dr Gupta.
Last but not the least, inspection of mouth ,nose and orbital surface is essential to check for any blackish discolouration.
Don’t wait it out — check with an ophthalmologist or ENT surgeon for further management.