This week we've seen reports of an infection called mucormycosis, sometimes called “Black fungus“, amongst patients with, or recovering from, COVID in India.
Fungal infections will be devastating. And on this case mucormycosis is adding to the burden of suffering in a rustic already in a deep COVID crisis.
By March this yr 41 cases Mucormycosis related to COVID-19 was documented worldwide, with 70% in India. Reports suggest. Number of cases Now there's quite a bit more, which is surprising given the present wave of Covid infections in India.
But what's mucormycosis, and the way is it linked to COVID-19?
What is mucormycosis?
Mucormycosis, formerly referred to as zygomycosis, is a disease attributable to many fungi that belong to the fungal family.Mucorales“
Fungi on this family are commonly present in the environment (eg, in soil) and are sometimes related to decaying organic material reminiscent of vegatables and fruits.
The member of this family that the majority often causes infection in humans is known as Rhizopus oryzae. In India though one other member of the family called. ApophysomycesFound in tropical and subtropical climates, can be common.
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In the laboratory, these fungi grow rapidly and have a dark/brown fuzzy appearance.
Family members that cause human disease grow well. At body temperature and in an acidic environment (seen when tissue is dead or dying or with uncontrolled diabetes).
How do you get mucormycosis?
Mucorales are considered opportunistic fungi, i.e. they Affects people in general. With a weakened immune system, or with damaged tissue. The use of immunosuppressive drugs reminiscent of corticosteroids can result in impaired immune function, as can other immunocompromising conditions, e.g. Cancer or transplant. Damaged tissue can occur after trauma or surgery.
There are 3 ways an individual can contract mucormycosis – by inhaling spores, swallowing spores in food or medicine, or when spores contaminate wounds.
Inhalation is probably the most common. We actually Take a breath Many fungus seeds every single day. But our immune system and healthy lungs often prevent them from causing infection.
When the lungs are damaged and the immune system is suppressed, as in patients with severe COVID, these spores can grow in our airways or sinuses and invade our body tissues.
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Mucormycosis can manifest within the lungs, but The nose and sinuses are the most common sites. of mucormycosis infection. From there it will probably spread to the eyes, possibly causing blindness, or to the brain, causing headaches or seizures.
It can even affect the skin. Life-threatening wound infections have been observed after injury. natural disasters or on Battlegrounds Where the wound has turn into contaminated with soil and water.
In the environment
We haven't seen mucormycosis infections related to Covid in Australia, and there have been only a few. Other countries. So why is the situation so different in India?
Before the pandemic, mucormycosis was already present Far more common than another country in India. It affects one's estimation. 14 per 100,000 people For example, 0.06 per 100,000 in Australia in comparison with 0.06 per 100,000 in India.
Globally, outbreaks of mucormycosis have been attributable to contaminated products e.g Hospital clothes, medicines and packaged food. But the widespread nature of reports of mucormycosis in India suggests that it just isn't coming from a single contaminated source.
Mucorales can be found Soil, rotting food, bird and animal droppings, water and air around construction sites, and in moist environments.
Although never comparable, it could be that we've got a lower ecological burden of mocorrels in Australia than in India.
Mucormycosis and diabetes
When diabetes just isn't controlled, blood sugar is high and the tissues are relatively acidic – a very good environment for the expansion of the Mucorrhizal fungus.
it was identity As a threat to mucormycosis in India (where diabetes is rampant and sometimes uncontrolled) and Worldwide Before the COVID pandemic.
Of all mucormycosis cases published in scientific journals worldwide between 2000-2017, Diabetes was observed in 40% of cases.
Fresh Abstract Mucormycosis related to COVID-19 showed that 94% of patients had diabetes, and it was uncontrolled in 67% of cases.
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An ideal storm
People with diabetes and obesity develop more. Severe COVID infection. This means they usually tend to receive corticosteroids, which are sometimes used to treat COVID-19. But corticosteroids – together with their diabetes – increase the danger of mucormycosis.
Meanwhile, COVID itself can damage airway tissues and blood vessels, which can even increase susceptibility to fungal infections.
So tissue and blood vessel damage from covid infection, treatment with corticosteroids, high background rates of diabetes within the population most affected by covid, and, importantly, a greater prevalence of fungi within the environment. Spreads in scale play a task in all of this. In the situation we're seeing in India with mucormycosis.
Treatment challenges
In Australia, as in lots of other Western countries, we've got seen increasing cases of one other fungal infection, Aspergillosis, in patients who had severe COVID infection, required intensive care management and received corticosteroids. This fungus is present in the environment but belongs to a unique family.
As is Aspergillosis The most common opportunistic fungus worldwideWe have tests for rapid diagnosis of this infection. But this just isn't the case with mucormycosis.
For many patients affected by mucormyosis, the final result is poor. About half of the patients were affected. will die And many will sustain everlasting damage.
Diagnosis and intervention as early as possible is crucial. This includes blood sugar control, prompt removal of dead tissue, and treatment with antifungal medications.
But unfortunately many infections There will be a late diagnosis And Limited access to treatment. This was the case in India before COVID and the present demands on the health system will only make things worse.
Increased awareness to manage these fungal infections, higher tests for his or her early diagnosis, concentrate on controlling diabetes and judicious use of corticosteroids, access to timely surgery and antifungal treatment, and more for prevention. Research shall be required.