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COVID-19: All you need to know about Black Fungus & its impact

With COVID-19 escalating across India in a ravaging second wave, a new infection called the “Black Fungus or Mucromyosis” has been rising among patients affected with Coronavirus. 
 
What is this new fungus? Why are patients getting affected by it? What is the treatment protocol? We explore in this article. 
 
What is Mucormycosis?
 
Mucormycosis is caused by a group of moulds called mucormycetes that are found throughout the natural environment. It often affects the sinuses, lungs, skin and brain. It mainly affects people who are on medication for other conditions, especially diabetes, that reduce their ability to fight environmental pathogens. 
 
The sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air. Warning signs include fever, headache, coughing, breathlessness, blood vomits and altered mental status. Maharashtra has recorded over 2,000 cases.
 
Why is it affecting COVID-19 patients?
 
Patients with uncontrolled diabetes are anyway at high risk of contracting covid-19. When this happens, they are treated with steroids which further compromises immunity. Doctors in India hold that steroids which are being used as a life-saving treatment for severe and critically ill covid-19 patients, can prove to be a trigger for mucormycosis. 
 
While steroids help in reducing inflammation in lungs they can decrease immunity and increase blood sugar levels in both diabetics and non-diabetic covid-19 patients alike. Patients with prolonged ICU stay are also at high risk of mucormycosis.
 
What are the symptoms of Mucormycosis?

 
The ICMR mentions sinusitis (nasal blockage or congestion), blackish/bloody nasal discharge and pain on the cheek bone. Other symptoms include pain on one side of the face, numbness or swelling, blackish discoloration over the bridge of nose/palate, loosening of teeth, blurred or double vision with pain, fever, skin lesion, blood clot, and chest pain.
 
What precautions can patients take?
 
Covid-19 patients should control hyperglycemia by regularly monitoring their blood glucose level post discharge. Diabetics should also monitor their blood glucose levels. Doctors have been advised to use antibiotics, antifungals and steroids judiciously. 
 
Hospitals should use clean, sterile water for humidifiers during oxygen therapy. Doctors have been warned not to miss warning signs and symptoms and not lose crucial time to initiate treatment. Use masks at dusty construction sites.
 
What is the treatment of Mucormycosis?

 
Patients should control diabetes and diabetic ketoacidosis. Doctors should reduce steroids in case the patient is still on them and discontinue rapidly. Immunomodulating drugs should also be discontinued. Doctors can go for surgery to remove all necrotic (dead) material. Antifungal therapy has also been advised for at least four to six weeks. Amphotericin B is being used for treatment, leading to a sudden increase in demand in some states.

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