‘’MUCORMYCOSIS’’ – Black Fungus
A deadly
disease which is killing people by the hundreds after they recovered from the
dreaded Covid-19 infection.
The
disease is Mucormycosis and can be
fatal. It catches on to those who have been on oxygen support for five days or
more. So, the oxygen which gives you life actually becomes your death sentence.
It's that dangerous.
Mucormycosis,
simply known as ‘Black Fungus’, develops in the nasal tract due to poor quality
of water used, through which the piped oxygen in hospitals passes to make it
hydrated oxygen, before it reaches the patient's nostrils. It's very much like
the fungus which develops on bread due to moisture, if kept for a long time.
It starts
from the nostril, travels towards the eye and then towards the brain. It
paralyses the nerves it travels through. So, first it’s the eye that loses
vision very swiftly and permanently. If not stopped, it enters the brain and
then it's a matter of a day or two before the person paralyses, has multiple
organ failure or sudden heart attack and dies.
For any
person on oxygen support in a hospital, it's crucial to keep looking around the
nostrils for any black pigmentation. As soon as it's noticed even as the
smallest dot, sirens should ring, and anti-fungal vaccination should start
immediately because this is the only treatment of the disease. Call an eye
surgeon or specialist at once on video call and show him or share a picture.
(The
injection dosage is 5 ml per kg weight. So if a person is 60 kg, it should be
300 ml, and if more, up to 80 kg, 400 ml.)
The
oxygen supply also needs to be sanitized immediately. While only distilled
water should be used for hydrating oxygen, in all hospitals, due to callosity,
negligence or downright ignorance, tap water or any other water available
around is used by the Medical Personnel. What is worse is that the container
for this water for hydrating the oxygen is seldom cleaned leading to
concentration of viruses and bacteria in the piped supply system, which cures
you from Covid-19 temporarily and then kills you with the deadly "Black
Fungus". Also, if tap water or even purified / boiled water is used in the
humidifier, over a period of time, there'll be deposits of impurities,
including micro-metals, minerals / salts which make things worse. Sadly, even
many senior doctors tend to overlook this crucial aspect of the life-giving
oxygen supply.
Hundreds
of people who were on oxygen support and had recently recovered from Covid-19
are dying of this disease every day. Because, by the time the black
pigmentation is noticed by family members at home, it's already too late and
even doctors are helpless. The most unfortunate part is the complete lack of
awareness about this contamination in oxygen supply and about the deadly
disease itself.
There has
not seen any discussion or advisory anywhere which shows our complete and
widespread ignorance about this dangerous "Black Fungus" lurking in
the oxygen supply system itself.
Checking
for Black Fungus on patients on oxygen support should be made an essential part
of COVID control protocol immediately if precious lives saved from COVID are to
be saved from this dangerous disease.
Mucormycosis
is a fungal infection caused by a group of molds called mucormycetes.
These fungi live throughout the environment, particularly in soil and in
decaying organic matter, such as leaves, compost piles or rotten wood.
People
get mucormycosis by coming in contact with the fungal spores in the
environment. For example, the lung or sinus forms of the infection can occur
after someone breathes in spores. These forms of mucormycosis usually occur in
people who have health problems or take medicines that lower the body’s ability
to fight germs and sickness. Mucormycosis can also
develop on the skin after the fungus enters the skin through a cut, scrape,
burn, or other type of skin trauma.
Types of Mucormycosis
1.
Rhinocerebral (sinus and brain)
mucormycosis is an infection in the sinuses that can
spread to the brain. This form of mucormycosis is most common in people with
uncontrolled diabetes and in people who have had a kidney transplant.
2.
Pulmonary (lung) mucormycosis is
the most common type of mucormycosis in people with cancer and in people who
have had an organ transplant or a stem cell transplant.
3.
Gastrointestinal mucormycosis is
more common among young children than adults, especially premature and low
birth weight infants less than 1 month of age, who have had antibiotics,
surgery, or medications that lower the body’s ability to fight germs and
sickness.
4.
Cutaneous (skin) mucormycosis
occurs after the fungi enter the body through a break in the skin (for example,
after surgery, a burn, or other type of skin trauma). This is the most common
form of mucormycosis among people who do not have weakened immune systems.
5.
Disseminated mucormycosis occurs
when the infection spreads through the bloodstream to affect another part of
the body. The infection most commonly affects the brain, but also can affect
other organs such as the spleen, heart, and skin.
Types
of fungi that most commonly cause Mucormycosis
Rhizopus species, Mucor species, Rhizomucor species, Syncephalastrum species, Cunninghamella
bertholletiae, Apophysomyces species,
and Lichtheimia species.
Symptoms of Mucormycosis
Rhinocerebral
(sinus and brain) mucormycosis include:
- One-sided facial swelling
- Headache
- Nasal or sinus congestion
- Black lesions on nasal bridge or
upper inside of mouth that quickly become more severe
- Fever
Symptoms of Pulmonary (lung) mucormycosis include:
- Fever
- Cough
- Chest pain
- Shortness of breath
Cutaneous (skin)
mucormycosis can look like blisters or ulcers, and
the infected area may turn black. Other symptoms include pain, warmth,
excessive redness, or swelling around a wound.
Symptoms of Gastrointestinal mucormycosis include:
- Abdominal pain
- Nausea and vomiting
- Gastrointestinal bleeding
Disseminated mucormycosis typically
occurs in people who are already sick from other medical conditions, so it can
be difficult to know which symptoms are related to mucormycosis. Patients with
disseminated infection in the brain can develop mental status changes or coma.
Risk & Prevention
People get mucormycosis through
contact with fungal spores in the environment. For example, the lung or sinus
forms of the infection can occur after someone inhales the spores from the air.
A skin infection can occur after the fungus enters the skin through a scrape,
burn, or other type of skin injury.
Mucormycosis is rare, but it’s more
common among people who have health problems or take medicines that lower the
body’s ability to fight germs and sickness. Certain groups of people are more
likely to get mucormycosis, including people with
- Diabetes, especially with diabetic
keto acidosis
- Cancer
- Organ transplant
- Stem cell transplant
- Neutropenia (low number of white
blood cells)
- Long-term corticosteroid use
- Injection drug use
- Too much iron in the
body (iron overload or hemochromatosis)
- Skin injury due to surgery, burns,
or wounds
- Prematurity and low birth weight
(for neonatal gastrointestinal mucormycosis)
Way to reduce the risk of Mucormycosis
It’s difficult to avoid breathing in
fungal spores because the fungi that cause mucormycosis are common in the
environment. For people who have weakened immune systems, there may be some
ways to lower the chances of developing mucormycosis.
- Protect
yourself from the environment. It’s important to note that although these
actions are recommended, they haven’t been proven to prevent mucormycosis.
1. Try to avoid areas with a lot of dust
like construction or excavation sites. If you can’t avoid these areas, wear an
N95 respirator (a type of face mask) while you’re there.
2. Avoid direct contact with water-damaged
buildings and flood water after hurricanes and natural disasters.
3. Avoid activities that involve close
contact to soil or dust, such as yard work or gardening. If this isn’t possible,
4. Wear shoes, long pants, and a
long-sleeved shirt when doing outdoor activities such as gardening, yard work,
or visiting wooded areas.
5. Wear gloves when handling materials
such as soil, moss, or manure.
6. To reduce the chances of developing a
skin infection, clean skin injuries well with soap and water, especially if
they have been exposed to soil or dust.
- Antifungal
medication.
If you are at high risk for developing mucormycosis, you should take
medication to prevent mucormycosis and other mold infections as per
doctor’s advice.
Diagnosis of Mucormycosis
Healthcare providers who suspect that
you have Mucormycosis in your lungs or sinuses might collect a sample of fluid
from your respiratory system to send to a laboratory. Your healthcare provider
may perform a tissue biopsy, in which a small sample of affected tissue is
analyzed in a laboratory for evidence of mucormycosis under a microscope or in
a fungal culture. You may also need imaging tests such as a CT scan of your
lungs, sinuses, or other parts of your body, depending on the location of the
suspected infection.
Information for
Healthcare Professionals about Mucormycosis
There are five major clinical forms of
mucormycosis; of these, rhinocerebral and pulmonary infections are the most
common. A classic clinical sign of mucormycosis is the rapid onset of
tissue necrosis with or without fever. Necrosis is the result of invasion of
blood vessels and subsequent thrombosis.
- Rhinocerebral
mucormycosis is
the most common form in patients with diabetes and with renal
transplants. It also occurs in neutropenic cancer patients and
hematopoietic stem cell transplant or solid organ transplant recipients.
Symptoms may include unilateral facial swelling, headaches, nasal or sinus
congestion or pain, serosanguinous nasal discharge and fever. As the
infection spreads, ptosis, proptosis, loss of extraocular muscle function
and vision disturbance may occur. Necrotic black lesions on the hard
palate or nasal turbinate and drainage of black pus from eyes are useful
diagnostic signs.
- Pulmonary
mucormycosis generally
occurs in patients with hematologic malignancy or profound neutropenia.
The symptoms are non-specific and include fever, cough, chest pain, and
dyspnea. Angioinvasion results in tissue necrosis, which may ultimately
lead to cavitation or hemoptysis.
- Cutaneous
mucormycosis may
be primary or secondary. Primary infection is usually caused by direct
inoculation of the fungus into disrupted skin and is most often seen in
patients with burns or other forms of local skin trauma and can occur
in patients who are not immunosuppressed. Primary infection produces an
acute inflammatory response with pus, abscess formation, tissue swelling,
and necrosis. The lesions may appear red and indurate and often progress
to black eschars. Secondary cutaneous infection is generally seen when the
pathogen spreads hematogenously; lesions typically begin as an
erythematous, indurate, and painful cellulitis and then progress to an
ulcer covered with a black eschar.
- Gastrointestinal
mucormycosis is
less common than the other clinical forms and is believed to result from
ingestion of the organism. It typically occurs in malnourished patients or
premature infants. The stomach, colon, and ileum are most commonly
affected. Non-specific abdominal pain and distension, nausea, and vomiting
are the most common symptoms, and gastrointestinal bleeding can occur. It
is the most common form of mucormycosis among neonates and is challenging
to diagnose partly because of its clinical resemblance to narcotizing
enterocolitis, a far more common disease.
- Disseminated
mucormycosis may
follow any of the forms of mucormycosis described above but is usually
seen in neutropenic patients with a pulmonary infection. The most common
site of spread is the brain, but the spleen, heart, skin, and other organs
can also be affected.
Transmission
Transmission occurs
through inhalation, inoculation, or ingestion of spores from the environment.
Although most cases are sporadic, healthcare-associated outbreaks have been
linked to adhesive bandages, wooden tongue depressors, hospital
linens, negative pressure rooms, water leaks, poor air filtration,
non-sterile medical devices, and building construction. Community-onset
outbreaks have been associated with trauma sustained during natural disasters.
Deaths rate due to Mucormycosis
Mucormycosis is frequently a
life-threatening infection. A review of published Mucormycosis cases found an
overall all-cause mortality rate of 54%. The mortality rate varied
depending on underlying patient condition, type of fungus, and body site affected
(for example, the mortality rate was 46% among people with sinus infections,
76% for pulmonary infections, and 96% for disseminated Mucormycosis).
