Mucormycosis is a serious fungal infection, sometimes also called “Black Fungus”. It has also been declared an epidemic by several states, including Maharashtra. Other fungal infections, including yellow and white ones, are also being detected in coronavirus patients. As the cases are on the increase, so are the number of questions that people have about them. Most people wonder what these infections are, why are they named after the colours and what is the reason behind their rise?
In an exclusive conversation with Mumbai Live, Dr Md. Shakeel Ahmed, Head-Emergency Medicine, Fortis Hiranandani Hospital, Vashi has answered some of these questions and also explained everything about these rare fungal infections.
Why is there a sudden rise in fungal infections – mucormycosis and aspergillosis – among recovered coronavirus patients?
With the recent surge in the number of COVID-19 cases during the second wave, the number of patients presenting with fungal infections have increased. Major contributing factors noted were poorly controlled diabetes and excessive use of steroids along with long term oxygen support for patients.
As reports are suggesting that the concept of Black Fungus and White Fungus is misleading, can you enlighten us about the same?
Colour coding of names of fungal infections can be misleading as it can create confusion. It is better to identify Mucormycosis and Aspergillosis by their name rather than colours. The colour of fungus can be seen differently if it develops in different areas.
Usually, Mucormycosis is seen as blackish necrotic eschars in the mucosal and cutaneous surfaces, hence people in common language prefer to name it Black Fungus.
When fungus attacks private parts, there is white colour discharge and thus, the name White Fungus.
Meanwhile, because of the yellow colour pus that is formed in the area wounded by the fungus people are calling it ‘Yellow Fungus’.
Now, cases of Yellow Fungus are also being reported. Who is at risk of developing this? What are the symptoms?
People who are immunocompromised, those receiving a high dose or long term steroids during the course of COVID-19 treatment, and poorly controlled diabetes are the ones who are at risk of this fungal infection.
The Yellow Fungus or mucor septicus usually presents as lethargy, decreased appetite and weight loss.
Were the fungal infections not detected during the first wave?
Initially, very few cases of fungal infections were reported previously but during this wave of the infection, the virus has become more aggressive causing extensive lung damages in patients requiring long term oxygen support and steroids to prevent the inflammation which has its impact on the blood sugars. All these factors have increased the risk of fungal infections.
Only people who have COVID-19 are at risk from these fungal infections or other people too are at risk?
Not only people with coronavirus infections, even people with other Immunocompromising conditions are at risk factor for Mucormycosis.
In the pre-COVID era, who were at high risks of contracting these fungal infections? And how?
Patients with uncontrolled diabetes mellitus, especially those with ketoacidosis, are at high risk. Other high-risk groups include patients with cancer, especially those who are neutropenic and receiving broad-spectrum antibiotics, and individuals receiving immunosuppressive agents, including oral or intravenous steroids.
Mucorales are ubiquitous fungi that are commonly found in soil and in decaying matter. Rhizopus can be found in mouldy bread. Given the ubiquitous nature of these fungi, most humans are exposed to these organisms on a daily or weekly basis.
Nonetheless, they rarely cause disease because of the low virulence of the organisms; instead, they mainly affect individuals with immunocompromising conditions.
Are these fungal infections a threat to life?
Mucormycosis carries a mortality rate of 50-80 per cent. The mortality rate associated with rhinocerebral disease is 50-70 per cent. Pulmonary and gastrointestinal (GI) diseases carry an even higher mortality rate because these forms are typically diagnosed late in the disease course.
Rhinocerebral disease causes significant morbidity in patients who survive, because treatment usually requires extensive, and often disfiguring, facial surgery.
Also Read: Mucormycosis: 131 hospitals to provide free treatment for fungal infection
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