Black fungus is also called mucormycosis. Black fungus is a fungal infection that causes the nose to turn black or discolored, blurred or double vision, chest pain, shortness of breath, and coughing up blood.
It is a very rare type of disease that caused a serious infection. It is caused by a group of moulds called mucormycetes present naturally in the environment.
This disease is closely related to diabetes and diseases that damage the immune system. Experts say that the excessive use of certain immune system-suppressing drugs during the COVID-19 pandemic may cause a surge.
According to data from the US Centers for Disease Control and Prevention, the death rate of black fungus is 54%, depending on the patient’s condition and the affected body part.
History of black fungus
The first case of black fungus was probably described by Friedrich Küchenmeister in 1855. Fürringer first described lung disease in 1876. In 1884, Lichtheim determined the development of this disease in rabbits and described two species; Mucor corymbifera and Mucor rhizopodiformis, later known as Lichtheimia and Rhizopus, respectively.
In 1943, its relationship with ineffectively controlled diabetes was accounted for in three cases with serious sinus, brain and eye involvement. In 1953, Saksenaea vasiformis, which caused several cases, was separated from the forest floor in India. In 1979, P. C. Misra inspected the soil of the Indian mango orchard, and they isolated Apophysomyces from it, and later discovered that it was the main cause of black fungus.
Since then, several species of hair algae have been described. When the case was reported in the United States in 1955, the author believed that it was a new disease caused by the use of antibiotics, ACTH and steroids.
Until the second half of the 20th century, the only treatment available was potassium iodide. In a review of lung cases diagnosed by bronchoscopy between 1970 and 2000, it was found that patients who underwent surgery and medical treatment (mainly amphotericin B) had a higher survival rate.
Causes of black fungus
Mainly, fungal spores floating in the environment can bring this infection to people. It can also be infected when the fungus “enters the skin through cuts, burns, or other types of skin trauma.”
After contact, the fungus will adhere to a certain part of the body and then spread inward through the nose, sinuses, or lungs. If the fungus penetrates the wound or burn, it may cause a local infection. But if it enters through the sinuses, it will affect the eyes and eventually the brain, leading to a fatal situation.
Some doctors believe that black fungus will take root when drugs are administered to Covid patients at home without monitoring blood sugar levels. Others said that due to the dirty and unsanitary living conditions of patients after the new coronavirus, it overwhelmed the suppressed immune system.
Steroids suppress the immune response, which increases vulnerability to secondary infections such as black fungus. The use of oxygen cylinders for tap water inlet meters is also the main culprit for this fungal infection. “Oxygen pipes and humidifiers contaminated with mold” may cause cases.
The symptoms of black fungus depend on where the fungus grows in the body. If you have symptoms that you think are related to black fungus, please contact your healthcare provider.
Symptoms of rhinocerebral (sinus and brain) mucormycosis or rhinocerebral black fungus include:
- Swelling on one side of the face
- Congestion of the nasal cavity or sinuses
- The black lesions on the bridge of the nose or the upper inside of the mouth quickly become more serious.
Symptoms of pulmonary (lung) mucormycosis or pulmonary black fungus include:
- Chest pain
- Shortness of breath
Symptoms of gastrointestinal mucormycosis or gastrointestinal black fungus include:
- Nausea and vomiting
- Abdominal pain
- Gastrointestinal bleeding
Cutaneous (skin) mucormycosis or cutaneous black fungus may look like blisters or ulcers, and the infected area may turn black. Other symptoms include pain around the wound, warmth, excessive redness, or swelling.
Types of black fungus
There are five types of black fungus. Those are-
1. Rhinocerebral (sinus and brain) mucormycosis: Rhinocerebral (sinus and brain) mucormycosis is a sinus infection that can spread to the brain. This form of mucormycosis is more common in uncontrolled diabetic patients and kidney transplant patients.
2. Pulmonary (lung) mucormycosis: Pulmonary (pulmonary) mucormycosis is the most common type of mucormycosis in cancer patients and patients undergoing organ transplantation or stem cell transplantation.
3. Gastrointestinal mucormycosis: Gastrointestinal mucormycosis is more common in young children than adults, especially in premature and low birth weight infants under one month who have received antibiotics, surgery, or medications that reduce the body’s ability to resist bacteria and diseases.
4. Cutaneous (skin) mucormycosis: Cutaneous (skin) mucormycosis occurs after fungus enters the body through the rupture of the skin (for example, after surgery, burns, or other types of skin trauma). This is the most common mucormycosis in people with an unweakened immune system.
5. Disseminated mucormycosis: Disseminated mucormycosis occurs when the infection is spread through the blood and affects other parts of the body. Infections most often affect the brain, but they can also affect other organs, such as the spleen, heart, and skin.
Risk factors of black fungus
Black fungus is rare, but it is more common in people who have health problems or take drugs that reduce the body’s ability to fight bacteria and disease. Certain people are more susceptible to black fungus, including the following people:
- Diabetes, especially with diabetic ketoacidosis
- Organ transplant
- Injection drug use
- Stem cell transplant
- Too much iron in the body
- Long-term use of corticosteroids
- Skin damage caused by surgery, burns, or wounds
- Premature delivery and low birth weight (for neonatal gastrointestinal mucormycosis)
Health care providers will consider your medical history, symptoms, physical examination, and laboratory tests when diagnosing black fungus. A healthcare provider who suspects mucormycosis or black fungus in your lungs or sinuses may collect a sample of fluid from your respiratory system and send it to a laboratory.
Your healthcare provider may perform a tissue biopsy, in which a small sample of affected tissue is examined in a laboratory to check for evidence of black fungus under a microscope or in fungal cultures. You may also need imaging tests, like CT scan of the lungs, sinuses, or other parts of the body, depending on where the infection is suspected.
Black fungus is a serious infection that must be treated with prescription antifungal drugs, usually amphotericin B, posaconazole, or isaconazole. These drugs are given by intravenous injection (amphotericin B, posaconazole, isaconazole) or orally (posaconazole, isaconazole).
Other drugs, including fluconazole, voriconazole, and echinocandin, are not effective against the fungus that causes black fungus. Black fungus often requires surgery to remove the infected tissue.
Patients may need up to six weeks of anti-fungal drugs to recover. The recovery depends on the diagnosis and treatment time of the disease.
It is difficult to avoid breathing fungal spores because the fungi that causes black fungus is very common in the environment. There is no vaccine to prevent black fungus. For people with weakened immune systems, there may be ways to reduce the chance of developing black fungus.
Protect yourself from environmental influences
It should be noted that although these measures are recommended, they have not been proven to prevent black fungus.
- Try to avoid dusty places such as construction sites or excavation sites. If you cannot avoid these areas, wear an N95 respirator (a mask) there.
- Avoid direct contact with water-damaged buildings and floods after hurricanes and natural disasters.
- Avoid activities that are in close contact with dirt or dust, such as yard work or gardening. Clean skin lesions thoroughly with soap and water, especially when they are exposed to soil or dust.
- Wear shoes, long trousers, and long-sleeved shirts when you are engaged in outdoor activities such as gardening, yard work, or visiting forest areas.
If you are at high risk of black fungus (for example, if you have had an organ transplant or stem cell transplant), your healthcare provider may prescribe medications to prevent black fungus and other mold infections. Doctors and scientists are still studying which transplant patients are at the highest risk and how to best prevent yeast infections.
Is black fungus contagious?
The disease is not contagious, which means it will not spread through human or animal contact. But it is spread by fungal spores in the air or the environment, which is almost impossible to avoid.
Bacteria and fungi are already present in our body, but the body’s immune system controls them. This system malfunctions due to the treatment of cancer, diabetes or the use of steroids, and then these organisms are used and multiplied.
How common is it?
The disease is distributed globally and is usually very rare, but due to lack of surveillance and comprehensive data, it is difficult to accurately estimate its prevalence. According to the CDC, between 1992 and 1993, 1.7 cases per million people per year.
However, this disease seems to be more common in India: Indian microbiologists published a study in the magazine of the journal Microorganisms in March shows that the prevalence of black fungus in India is 70 times than the world data.
What kind of people are more at risk?
People who are immunosuppressed are more susceptible to infection, including Covid-19 patients, diabetics, people taking steroids, and people with other comorbidities such as cancer or organ transplants. Covid patients with diabetes need special care.
ICMR said that controlling diabetes is one of the best preventive measures for this disease. This disease is mainly seen in people who have recovered from Covid or are recovering. If it is not treated, it will cause lethal bloodstream infection.
If fungi are so common, why are we rarely infected?
Thanks to Allah, he created the body’s defense system, which constantly and tirelessly fights against these ubiquitous creatures, and we keep them out of the door from infection. Once our immune system relaxes its vigilance, these organisms will take advantage of and cause diseased and often fatal infections.
What are the risks of black fungus?
The mortality rate of black fungus is very high. According to the data currently available, if the patient does not receive treatment for a long time or goes untreated, then the mortality rate is as high as 80%.
Mortality varies according to the patient’s basic condition, fungus type, and affected body parts (for example, the mortality rate for sinus infection is 46%, the mortality rate for lung infection is 76%, and the mortality rate for disseminated mucormycosis is 96%).
If gets treatment in time then it is still 40-50%. In addition, according to doctors, the drugs used to treat this disease have strong side effects. In some cases, this can lead to “kidney problems, neurological dysfunction, and stroke.”
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