COVID-19-triggered mucormycosis cases rise in India: Symptoms, treatment and risk factors of deadly black fungal infection

Even as the world is grappling with the continuing effects of the COVID-19 pandemic, a new health issue appears to be quickly reaching the potential of an outbreak in India. Mucormycosis, a type of rare but deadly black fungal infection has been found in patients recovering from COVID-19 and is being referred to as COVID-19 triggered mucormycosis in this context. Reports suggest that ENT surgeons at Delhi’s Sir Ganga Ram Hospital (SGRH) have found 13 cases in the last fortnight and around half the patients lost their eyesight as a result. Cases have also reportedly emerged in Ahmedabad and Mumbai, with 44 patients (nine out of whom passed away) having been recorded at the Ahmedabad Civil Hospital. Mucormycosis history in India Though these cases are currently emerging in the aftermath of COVID-19 infection, the fungal infection mucormycosis itself is neither new to this world nor to India specifically. The US Centers for Disease Control and Prevention (CDC) says that mucormycosis is caused by a group of fungi or molds called mucormycetes of the order Mucorales. MedlinePlus suggests that these mucormycetes can be naturally found in decaying organic matter like spoiled bread, fruit, vegetables and compost piles. It’s therefore quite normal to come across this fungus during your lifetime. However, what’s more important to note is these mucormycetes usually cause an infection in those with a weakened immune system and usually affects the sinuses, brain or lungs. A study published in the journal Mycoses in 2014 explains that certain species of fungi like Apophysomyces elegans and Rhizopus homothallicus are emerging in the Indian subcontinent, leading to an alarming frequency of mucormycosis in India in the last decade. The study also notes that Indian mucormycosis has certain unique features which is why it’s often categorised as rhino-orbital-cerebral mucormycosis (ROCM). Given the new association with COVID-19, it’s more important than ever to control and prevent mucormycosis in India. Symptoms of mucormycosis The CDC notes that the symptoms of mucormycosis depend on where in the body the fungus is growing. ROCM, which affects the sinuses, brain and mouth, is likely to present with the following symptoms:

• Nasal or sinus congestion
• Swelling in one side of the face
• Fever
• Headache
• Black lesions on the nose bridge and/or the upper hard palate inside the mouth

Pulmonary mucormycosis, which affects the lungs, has symptoms like fever, cough, chest pain and shortness of breath, all of which are also symptoms associated with COVID-19. Gastrointestinal mucormycosis symptoms include abdominal pain, nausea, vomiting and gastrointestinal bleeding. Mucormycosis can also affect the skin and have very disseminated symptoms when it occurs in people who are sick or have had to be hospitalised and stayed in the intensive care unit (ICU). Treating mucormycosis The CDC says that there is currently no vaccine for mucormycosis. Antifungal medications like amphotericin B, posaconazole and isavuconazole — which can be given orally or intravenously - are often effective in treating mucormycosis. However, if the progression of the infection cannot be stopped or if it affects a large area, surgery may be needed to remove the infected tissue. Such surgical removals have already been reportedly deemed necessary in some of the cases at Delhi’s SGRH, where the nose and jawbone of some patients had to be removed. Risk factors and prevention The CDC says that mucormycosis usually occurs in immunocompromised people, especially those suffering from diabetes, cancer, HIV, neutropenia (low white blood cell count), hemochromatosis (excess iron in the body) and infectious diseases. Long-term corticosteroid use, injection drug use, going through an organ or stem cell transplant and being born prematurely can also make you more susceptible to this disease. A study published in the journal Medical Mycology in 2019 points out that in Indian mucormycosis cases, the most common risk factors are uncontrolled diabetes, trauma injuries and post-lung infection susceptibility. The CDC notes that mucormycosis is not contagious, and usually occurs when someone inhales the fungal spores directly. The best way to prevent mucormycosis, therefore, relies on preventing contact with fungal spores. You can take the following precautions:

• Avoid water-damaged areas, foods that have spoiled and construction or excavation sites.
• Wear a mask. Fungi may be present in the environment but wearing a mask can keep you from inhaling spores.
• Keep your home environment fungus and spore-free. Clean your refrigerator and pantry regularly and dispose of spoiling foods without delay.
• Boost your immune system and don’t take unnecessary risks if you are immunocompromised, have an underlying disease or have had a surgery or transplant recently.
• Keep a track of your health and focus on keeping your blood sugar, blood pressure, weight and cholesterol under control.

For more information, read our article on Fungal infections. Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.