Mucormycosis – Black Fungus
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What is Mucormycosis / Black Fungus
Mucormycosis, also known as black fungus, is increasingly common among immunocompromised individuals, primarily caused by fungi from the Mucoromycota phylum, notably Lichtheimia, Rhizopus, and Mucor. Rhizopus is the most prevalent genus.
Risk factors include immunosuppression, transplantation, excessive iron, and diabetes mellitus, especially in diabetic ketoacidosis. The infection presents in various forms, affecting areas like the eyes, skin, lungs, and gastrointestinal tract. Invasive forms are aggressive, causing tissue necrosis and blood vessel thrombosis.
Early diagnosis and aggressive treatment with high-dose antifungal medications like liposomal amphotericin B are crucial for survival, but may not always improve patient longevity. Severity depends on factors like infection site, extent of spread, treatment delay, neutropenia, age, and concurrent infections.
Symptoms
Treatments
Precautions
Symptoms
Mucormycosis / Black Fungus symptoms include
- Fever
- Headache
- Reddish swollen skin over the nose and around the eyes
- Visual abnormalities
- Eye swelling
- Ocular pain
- Facial edema
- Shortness of breath
- Diplopia (double vision), particularly in diabetic patients
- Sinus pain
- Proptosis (bulging eyes)
- Periorbital swelling (swelling around the eyes)
- Orbital apex syndrome
- Ulcer of the palate
- Cranial nerve palsy
Treatments
- Early Diagnosis: Diagnosing promptly is crucial, often done through imaging studies and nasal endoscopy.
- Addressing Predisposing Factors: Managing underlying conditions like diabetes and controlling hyperglycemia can prevent fungal invasion. Limiting immunosuppressant drugs is also important.
- Surgical Removal: Whenever possible, infected tissues are surgically excised, especially in rhino-cerebral infections, to prevent spread and improve cure rates.
- Antifungal Therapy: Amphotericin B, particularly the liposomal form, is the preferred drug due to its effectiveness and CNS penetration. Posaconazole is an alternative option.
- Adjunctive Therapies: Iron chelators and hyperbaric oxygen therapy can complement antifungal treatment by inhibiting fungal growth.
Precautions
Precautions for Mucormycosis
- Maintaining Hygiene: Regularly wash the affected areas with soap and water, especially in cases of skin injuries, as they can serve as entry points for fungal infections.
- Enhancing Immunity: Incorporate foods rich in probiotics, such as yogurt and fermented foods, to enrich the body with good bacteria. Additionally, consume antifungal products like apple cider vinegar, tea tree oil, coconut oil, turmeric, garlic, neem leaves, and others known for their antifungal properties.
- Managing Blood Sugar Levels: Maintain glycemic control, especially for diabetic patients, as high blood sugar levels can increase susceptibility to fungal infections.
- Engaging in Physical Activities: Regular physical activity helps maintain a healthy weight, which can aid in mitigating the risk of Mucormycosis.
Types of Mucormycosis / Black Fungus
Before Surgery
During the Surgery
After the Surgery
Before Surgery
- Early Diagnosis: Rapid and accurate diagnosis using histopathology, microscopy, and PCR tests.
- Patient Evaluation: Detailed history and clinical assessment to plan surgery.
- Imaging Studies: CT scans and endoscopy for visualizing affected areas.
- Controlling Predisposing Factors: Managing conditions like diabetes and limiting immunosuppressants.
- Surgical Planning: Excision of infected tissues based on infection type and extent.
- Antifungal Therapy: Administering drugs like Amphotericin B or posaconazole before surgery.
- Adjunctive Therapies: Consideration of iron chelators and hyperbaric oxygen.
- Monitoring: Regular follow-up for early detection and intervention.
During the Surgery
How you prepare for Mucormycosis Surgery
- Early Diagnosis: Identifying characteristic symptoms, patient history, and specialized tests aid in diagnosis.
- Surgical Removal: If feasible, infected tissues are excised, particularly in rhino-cerebral or cutaneous cases.
- Antifungal Therapy: Administering antifungal medications like Amphotericin B or posaconazole to reduce fungal load.
- Adjunctive Therapies: Considering additional treatments such as iron chelators or hyperbaric oxygen therapy to enhance treatment efficacy.
- Monitoring: Regularly monitoring the patient’s condition to ensure surgical success and prevent complications.
- Preventing Recurrence: Taking measures to control predisposing factors like diabetes and immunosuppression.
- Patient Education: Educating patients about post-operative care and the importance of adherence to medication and follow-up appointments.
After the Surgery
How you prepare for Mucormycosis Surgery
- Monitor the patient’s condition regularly to check surgical outcomes and prevent infection recurrence.
- Provide proper wound care to promote healing and prevent infections.
- Continue antifungal medication to eradicate any remaining fungal infection and prevent relapse.
- Consider adjunctive therapies like iron chelators or hyperbaric oxygen therapy to boost immune response and inhibit fungal growth.
- Offer rehabilitation if needed to aid in the patient’s recovery.
- Educate patients and caregivers about infection signs, wound care, and medication adherence
- Schedule follow-up appointments to track progress and adjust treatment as necessary for optimal recovery.
Mucormycosis Black Fungus FAQs
How serious is this black fungus?
It is a vision-threatening and life-threatening condition. A high index of suspicion is very important here.
Which specialist should I visit for black fungus?
Is black fungus treatable?
Why the sudden increase in black fungus cases?
t may be triggered by extensive use of steroids, which is a life-saving treatment for moderate to severe COVID-19 infection. Steroids lower the immunity and also cause a sudden up-shooting of blood sugar levels in diabetics as well as non-diabetic patients.
For patients on humidified oxygen, care should be taken to make sure there is no water leak, to prevent the growth of the fungus.
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