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Black Fungus

A rapid rise in cases of mucormycosis, also known as black fungus, has added to the challenges faced by India’s healthcare system as it deals with a massive second wave of Covid-19 infections. The following lays out information about mucormycosis, opinions from health experts and the scientific evidence behind what could be driving the recent rise in cases.
What is mucormycosis?
Mucormycosis is a fungal infection that causes blackening or discoloration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood. It is a rare type of fungal infection that occurs through exposure to fungi called mucormycetes. These fungi commonly occur in the environment, particularly in leaves, soil, compost and animal dung. Mucormycetes can enter the body through breathing, inhaling and exposed wounds in the skin. The disease has a close link to diabetes and conditions which compromise the immune system. Experts have said that an overuse during the Covid-19 pandemic of certain drugs which suppress the immune system could be causing the surge. Data from the US Center for Disease Control and Prevention shows that mucormycosis has a mortality rate of 54%, which can vary depending on the condition of the patients and the body part affected.
Is it contagious?
The disease is not contagious, which means that it cannot spread from contact between humans or animals. But it does spread from fungal spores that are present in the air or in the environment, which are almost impossible to avoid. But it needs to be understood that there are fungi as well as bacteria present in our bodies but they are kept under control by our body’s immune system. When the immune system is compromised due to irrational use of steroids, diabetes, cancer treatment, it allows these bacteria and fungi a chance to multiply and spread infection.
What is the link to Covid-19?
Covid-19 leads to a weakened immune system, preventing the body from effectively protecting against infection. As a result, Covid patients are particularly susceptible because not only does the virus affect their immune system – treatment drugs can also suppress their immune response.
Mucormycosis can occur any time after Covid-19 infection, either during the hospital stay or several days to a couple of weeks after discharge.
The Covid-19 causes favourable alteration in the internal milieu of the host for the fungus and the medical treatment given, unwittingly also abets fungal growth. Covid-19 damages the airway mucosa and blood vessels. It also causes an increase in the serum iron which is very important for the fungus to grow. Medications like steroids increase blood sugar. Broad-spectrum antibiotics not only wipe out the potentially pathogenic bacteria but also the protective commensals. Antifungals like Voriconazole inhibit Aspergillosis but Mucor remains unscathed and thrives due to lack of competition. Long-term ventilation reduces immunity and there are speculations of the fungus being transmitted by the humidifier water being given along with oxygen. All these make a perfect recipe for mucormycosis infection.