Black Fungus

What is this Black Fungus?

Now it is called black fungus because black patches are seen on the nose the mouth as well as on the face skin of patients who are affected by this fungus. The fungus is not actually black but the fungus invades the blood vessels and it blocks the blood supply of the tissues. The tissues die which appear as black patches. So they are actually dead tissue that you see as black patches.

Why are people suddenly affected by it?

Now, normally the fungal spores are present in the air. They are also present in the nose in our body. Now whenever our defense mechanism reduces or the body’s immunity is low that is which is seen in covid infections and in patients with uncontrolled diabetes. In those patients this is normally present and the fungus invades inside the mucosa of the lining of the air passages and affects the rest of the system.

Who is at risk for developing black fungus?

So patients with uncontrolled diabetes, patients who have had severe covid who have need ventilator support who needed high flow oxygen for long periods of time patients who have been given steroids tosylisima this reduces the immunity and increases the susceptibility to this fungal infection. Also patients who have less neutrophil count, patients who are immuno compromised that is who have cancer, patients who are organ transplant patients who are on immunosuppressive agents these patients are then more prone to get this fungal infection. Also patients who have high iron levels, high interleukin 6 levels and patients who are on iron chelating agents like d fedoxamine are at increased risk of getting this infection.

Black fungus symptoms to look for during covid infections and even after recovery from covid?

This black fungus starts in the nose spreads to the sinus then to the eye and then to the brain. So the earlier symptoms are seen in the nose you will see blood tinged or dirty discharge from the nose there can be nose block or nose stuffiness. There can be black spots seen inside the nose or on the roof of the mouth when you open the mouth there can be face pain because the nerve supplying the face is affected there can be altered sensation or numbness on the face numbness or loss of sensation in the teeth. There can also be a severe headache because once the sinuses are full you can have a sinus headache and once it affects the eye you can have eye symptoms like you can have drooping of the eyelid so one eye appears smaller than the other. You can have a double vision because the eye movements are affected sometimes the eye can be red watery and bulgy and sometimes you can have severe eye pain and in some patients without any visible signs there can be loss of vision because the blood supply to the eye is affected and this you can diagnose only if you close one eye and see. When you look with both your eyes open you will not know that there is less vision in one eye. From the eye when it spreads to the brain you can have fits you can have hemiplegia and various other neurological symptoms in advanced stages also you can see red or blue color discolored patches on the face skin on the eyelid skin you can have black patches on the face which is also an advanced stage of this infection.

Does it spread from person to person?

No. It does not spread from person to person.

Do oxygen humidifiers and oxygen delivery masks are causing the outbreak?

Now these are all speculations. There has been no proven evidence to say that these oxygen delivery systems are causing this. However, it is a good practice to use sterile water for humidification. You need humidified oxygen only for your respiratory system and you can use disposable tubing, you can maintain the hygiene of the oxygen masks and some people ask me whether methylene blue in the humidifier bottle will help. This helps only the candida infection and not mucor infection so it may not be useful in this kind of infection.

Is industrial oxygen responsible for the spot?

Now you must understand that all the oxygen that we make comes from the air. Normally air has about 21 percent oxygen. The medical grade oxygen has got 99 % oxygen and the industrial oxygen has 95 percent oxygen. So the so called impurities in the industrial oxygen is actually the normally present gases. They are extra gases which we normally inhale and therefore it is not impure. Now some people ask me whether these oxygen concentrators are safer or better than industrial oxygen to prevent mucor. So we use oxygen concentrators only for mild patients who are at home. So anyways mucor is seen lesser in patients with milder covid infection. These concentrators have lower concentration of oxygen about 90 percent and they give the oxygen at a lower flow and it is not indicated for people who require high flow oxygen in whom we see the mucor infection more commonly.

Should patient in Home Isolation worry about Mucormycosis?

Patients who are in home isolation anyways have mild disease in which mucor is seen less commonly. If we do see mucor infection in home isolation patients and therefore we advise you not to self-medicate by seeing google and don’t start taking antibiotics or steroids by yourself and also patients who are already diabetics don’t continue with the same dose of anti-diabetics. Now the covid infection affects the pancreas affects the insulin sensitivity and therefore your dose that you require of anti-diabetic medication will change. So you have to be under your doctor’s supervision and follow the dose as advised by them because uncontrolled diabetes is the commonest cause of mucor infection.

Can I recover once I get black fungus?

This is a very common question that I get so when you have fungal infection in the nose or in the paranasal sinus or when the eye is affected in the early stage, we can definitely treat it with good antifungals and some amount of surgery. However when the eye is very severely affected sometimes we have to even remove the eye to reduce the bulk of the infection in order to save the life of the patient because from the eye it very easily spreads to the brain and once it affects the brain there is a very high risk to the life of the patient. Therefore we are doing all this kind of awareness to make you aware that once you have no symptoms or sinus symptoms you must immediately consult your eye doctor, especially oculoplastic doctor.

What can be done to prevent this infection?

The people who are at high risk should be closely watched. So a diabetic patient’s diabetes or sugar levels should be strictly controlled to scilicimab or steroid medication should be given in covid patients only according to the national protocols. They should not be inadvertently used for every patient. We see patients with mild disease at home. They look at google start taking steroids and all other kinds of medications by themselves. This can be risky and this can predispose you to getting mucor. So steroids can be used because they are life-saving in covid infection but they should be used for short duration for about seven to ten days under strict medical supervision and sugar has to be controlled when you are taking steroids. Also it is very difficult to diagnose this infection in the covid wards because with a PPE doing an endoscopy is quite difficult. However the people who are treating covid patients should at least do examination of the nose and the mouth to pick up these early black patches and you know these are the early signs that we can pick and treat these cases also maintenance of the hygiene of the oxygen delivery systems is important. Maintaining good mucosal health by betadine goggles and steam inhalation is advisable and again I would like to say that do not self-medicate. You should not take steroids dosilicimab or any other diabetic medications by yourself be under constant medical supervision so that you have less risk of developing this black fungus.

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