From warning signs to right treatment, experts answer important questions about Mucormycosis

Patients with uncontrolled diabetes are susceptible to mucormycosis

This is important to understand. The term ‘black fungus' - or yellow or white fungus for that matter - has no basis in medical terminology. It's a misnomer. The technical word for the disease is mucormycosis, a non-contagious fungal infection that manifests itself with the skin or areas within the mouth turning into one of these colours. Nor is it something that has cropped up out of the blue - it was first recorded in the 19th century. It's just that the condition has started affecting people who have recovered from Covid-19 with alarming frequency in the second wave of the pandemic. A dentist recently shared, for example, how a 38-year-old patient she had been treating, who had recovered from Covid-19, developed the disease, losing seven of his teeth within a month. But what exactly causes it? What are the symptoms? Who is most susceptible to it? And what is the correct method of treatment? Two experts give us clarity on these questions, at a time when the right information about this potentially fatal disease is of utmost importance.

Mucormycosis has affected many Covid-19 patients in India

Cause and effect
First things first. The fungus that causes mucormycosis falls under the mold category. In other words, it can even emanate from substances like rotten bread or fruits, or any type of humid environment. "The question then is, why are more people not affected by it, given how it's prevalent across the globe?" asks Dr Dip Narayan Mukherjee, a consultant who specialises in clinical microbiology and infectious diseases. He adds, "The answer is that healthy people have the requisite immune system to fight it. We don't allow it to grow inside our bodies."

Dr Mukherjee also tells us that even in the case of Covid-19 patients, not everyone is susceptible to it. The disease mainly affects those who already had conditions such as uncontrolled diabetes, cancer or AIDS, or were administered immunosuppressants for reasons including organ transplants. "Uncontrolled diabetes, for instance, causes decreased immunity and Covid-19 aggravates that situation, changing the patient's blood-sugar system. That makes them vulnerable to invasive fungal infections and it can be a disaster if they are given steroids with imporper indication or dosage at this stage," the expert warns.

Dr Dip Narayan Mukherjee

Implantologist and dentist Dr Ratnadeep Patil, founder of Smile Care dental clinic in Bandra, adds two more possible reasons behind the recent surge in murcormycosis cases in India. He says that we should consider how a lot of places and industries were shut down completely during the first lockdown. "Fungus gets a chance to grow when there is no movement," he explains (and this is especially true for a humid country like India). The doctor also says that there is a debate around patients being treated with industrial oxygen cylinders, which aren't pure like medical oxygen. "We don't know what sort of fungi these cylinders contain," he reasons.

The right treatment
Given these reasons, what are the warning signs that people should look out for? Dr Patil tells us that in the case of rhino-cerebral mucormycosis, the fungus enters through the nose and goes into a person's sinus. From there, it can travel upwards towards the eye, or downwards towards the gum and teeth. That's why symptoms include mild headaches, nasal discharges, pain in the cheeks, ear or teeth, or the palate developing a blackish area. "Extra-orally, you might see a blackish bruise near the eye. These are early signs and it's great if the treatment can begin at this stage," he says, with Dr Mukherjee adding that pulmonary mucormycosis symptoms include cough, fever, or shortness of breath.

Dr Ratnadeep Patil

The treatment for the disease, Dr Mukherjee continues, is divided into three categories. One is to control the person's sugar levels. This is the first stage. Next, the patient will need surgical debridement, a procedure to remove infected tissues. "Anti-fungal drugs won't work on these tissues because they are already dead. So, they have to be surgically removed. If it has reached the eye, for example, a surgeon might have to remove the eye, sacrificing it to save the body," he says, adding that administering anti-fungal drugs over a period of some months is the third stage of treatment, though these drugs are expensive.

Early detection
But what's of crucial importance is to self-diagnose if a person develops any symptoms since it's critical to start the recovery process as soon as possible, and because patients have usually returned home after recovering from the virus when these symptoms develop. The medical fraternity, too, is joining forces to combat the disease in a multi-disciplinary way. Dr Mukherjee tells us that infectious diseases specialists like him are constantly working in close liaison with dentists, eye doctors, ENT specialists and general physicians to share their knowledge when a patient shows signs of the illness. So, let's take a moment to extend our gratitude to them, because these are the people on whom our future rests.

Warning signs
>> The symptoms for rhino-cerebral mucormycosis include mild headaches, nasal discharges, and pain in the cheeks, ear or teeth. Those with pulmonary mucormycosis might get fever or feel shortness of breath.