MUCORMYCOSIS - BLACK FUNGUS, A NEW CAUSE OF DEATH DURING COVID CRISIS

 

‘’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).