Mucormycosis is a serious but rare fungal infection caused by a group of molds called mucormycetes. It is caused by exposure to mucor mould which is commonly found in soil, plants, manure, and decaying fruits and vegetables.

When people inhale the fungal spores, the spores enter the sinuses and spread to airways deeper in the body through mucous membrane into the bones. It can also proceed through the bones to the eyes, eye socket, muscles and nerves."  

It affects the sinuses, the brain and the lungs and can be life-threatening. If not controlled, not treated, it can have mortality (rate) of anything from 20% to 50%.

Initial symptoms are often quite common-looking:

·        Red eyes or a reddened nose

·        bloody or black nasal discharge

·        fever

·        headache and

·        difficulty breathing

Patients suffering from the fungal infection typically have symptoms of:

·        stuffy and bleeding nose

·        swelling of and pain in the eye

·        drooping of eyelids and

·        blurred and finally, loss of vision

As the infection spreads, ptosis, proptosis, loss of extraocular muscle function, and vision disturbance may occur.

A classic clinical sign of mucormycosis is the rapid onset of tissue necrosis with or without fever. Necrotic black lesions on the hard palate or nasal turbinate and drainage of black pus from eyes are useful diagnostic signs.

A definitive diagnosis of mucormycosis typically requires histopathological evidence or positive culture from a specimen from the site of infection. 

·        The first steps in treating mucormycosis are intravenous (IV) antifungal medications.

·        In addition, surgical debridement or resection of infected tissue is often necessary

Common antifungal medications that may prescribe for mucormycosis include:

• Amphotericin B
• Posaconazole
• Isavuconazole 

Cure may also involve a 4-6 weeks course of intravenous anti-fungal therapy. 

Note: Controlling diabetes & judicious use of steroids is one of the foremost prevention methods suggested by ICMR.

·        Controlling diabetes is one of the foremost prevention methods suggested by ICMR. Hence, Covid-19 patients who diabetic need to take utmost care.

·        Steroids should never be administered at an early stage of early stage of Covid-19. They should be taken only after sixth day of infection.

·        Other than steroids, use of Covid-19 drugs such as Tocilizumab, Itolizumab also suppresses the immune system. And when these drugs are not used appropriately, it increases the risk, as our immune system fails to fight the fungal infection.

·        For patients on oxygen therapy, it should be ensured that the water in the humidifier is clean and is refilled regularly. Attention should be paid to ensure there is no leakage of water (to avoid wet surfaces where the fungus can breed).

·        Patients should maintain proper hygiene by keeping their hands as well as body clean. Mask should be cleaned regularly or use new masks.

·        Avoid traditional method of corona treatments such as using moist soil, cow dung, dirty water etc. 

https://www.cdc.gov/fungal/diseases/mucormycosis/index.html

https://www.sciencedirect.com/topics/medicine-and-dentistry/mucormycosis

https://www.healthline.com/health/mucormycosis#treatment

https://www.dw.com/en/covid-19-in-india-patients-hit-by-rare-black-fungus/a-57510453

https://www.bbc.com/news/world-asia-india-57027829

https://timesofindia.indiatimes.com/india/covid-19-and-black-fungus-infection-dos-donts-symptoms-treatment/articleshow/82634153.cms

https://edition.cnn.com/2021/05/21/india/black-fungus-mucormycosis-covid-explainer-intl-hnk/index.html

https://www.thedailystar.net/bangladesh/news/two-black-fungus-cases-detected-2098309

https://www.tbsnews.net/coronavirus-chronicle/covid-19-bangladesh/black-fungus-detected-bangladesh-250519

Note: For informational purposes only. Consult your textbook for advising your patients.