Table of Contents
What is Mucormycosis?
Mucormycosis or Black Fungus is a fungal infection that mainly affects people who are on medication for other health problems that reduce their ability to fight environmental pathogens.
Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air.
Mucormycosis – if uncared for – may turn fatal
This can lead to serious disease with a warning sign and symptoms as follows:
Mucormycosis Symptoms
- Pain and redness around eyes and/or nose
- Fever
- Headache
- Coughing
- Shortness of breath
- Bloody vomits
- Altered mental status
Predisposing Factors
- Uncontrolled diabetes mellitus
- Immunosuppression by steroids
- Prolonged ICU stay
- Co-morbidities – post-transplant/malignancy
- Voriconazole therapy
How to Prevent Mucormycosis
- Use masks if you are visiting dusty construction sites
- Wear shoes, long trousers, long sleeve shirts and gloves
- while handling soil (gardening), moss or manure
- Maintain personal hygiene including thorough scrub bath
When to Suspect (in COVID-19 patients, diabetics or immunosuppressed individuals )
- Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone
- One sided facial pain, numbness or swelling
- Blackish discoloration over bridge of nose/palate
- Toothache, loosening of teeth, jaw involvement
- Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
- Chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms
Do
- Control hyperglycemia
- Monitor blood glucose level post-COVID-19 discharge and also in diabetics
- Use steroid judiciously – correct timing, correct dose and duration
- Use clean, sterile water for humidifiers during oxygen therapy
- Use antibiotics/antifungals judiciously
Don’t
- Do not miss warning signs and symptoms
- Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
- Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDI-TOF), for detecting fungal etiology
- Do not lose crucial time to initiate treatment for mucormycosis
How to Manage the case of Mucormycosis
- Control diabetes and diabetic ketoacidosis
- Reduce steroids (if patient is still on) with aim to discontinue rapidly
- Discontinue immunomodulating drugs
- No antifungal prophylaxis needed
- Extensive Surgical Debridement – to remove all necrotic materials
How Is Mucormycosis Treated?
Medical treatment
- —- Install peripherally inserted central catheter (PICC line)
- —- Maintain adequate systemic hydration
- —- Infuse Normal saline IV before Amphotericin B infusion
- —– Antifungal Therapy, for at least 4-6 weeks (see the guidelines below )
- Monitor patients clinically and with radio-imaging for response and to detect disease progression
Team Approach Work Best
- Microbiologist
- Internal Medicine Specialist
- Intensivist
- Neurologist
- ENT Specialist
- Ophthalmologist
- Dentist
- Surgeon (maxillofacial/plastic)
- Biochemist
SOURCE: DEPARTMENT OF HEALTH RESEARCH, MINISTRY OF HEALTH AND FAMILY WELFARE, GOVERNMENT OF INDIA (Download PDF https://www.icmr.gov.in/pdf/covid/techdoc/Mucormycosis_ADVISORY_FROM_ICMR_In_COVID19_time.pdf)
Detailed management guideline & information available on the following
