Mucormycosis

The symptoms of mucormycosis may vary depending on the body part affected and the severity of the infection. Some common signs and symptoms of mucormycosis based on the type of infection include:

1. Symptoms of Rhino-Orbito-Cerebral Mucormycosis

Non-Ophthalmic Symptoms

• Headache
• Fever
• One-sided facial swelling
• Nosebleed
• Nasal discharge
• Sinusitis
• Facial numbness
• Facial nerve paralysis (Bell’s palsy)
• Ulcerations in the nose
• Toothache
• Bone destruction
• Alterations in mental status

Ophthalmic Symptoms

• Eye pain
• Decreased vision
• Paralysis or weakness of eye muscles
• Bulging of the eyes
• Irritation in the eyes
• Drooping of the upper eyelid
• Infection of the soft tissues of the eye socket
• Black lesions on the nasal bridge or upper inside of the mouth

2. Symptoms of Pulmonary Mucormycosis

• Fever
• Cough
• Chest pain
• Shortness of breath
• Blood in sputum

3. Symptoms of Gastrointestinal Mucormycosis

• Abdominal pain
• Nausea
• Vomiting
• Gastrointestinal bleeding
• Diarrhea
• Abdominal distention
• Perforations in the intestine or stomach

4. Symptoms of Cutaneous (Skin) Mucormycosis

• Erythematous to purple lesions that become necrotic
• Ulcers
• Tender nodules
• Lesions filled with pus
• Pain, warmth, excessive redness, or swelling around a wound

5. Symptoms of Renal Mucormycosis

• Fever
• Lower back pain
• Decreased urine output
• Blood in the urine

Want to know more about mucormycosis? To get all your FAQs answered on mucormycosis, watch this video!

Mucormycosis is an infectious disease caused by a group of fungi belonging to the class Zygomycetes and the order Mucorales. These fungi can be found in:

• Soil
• Animal excreta
• Compost piles
• Rotten leaves
• Wood

Despite their common presence in nature, these molds rarely cause issues. However, they can induce severe, even life-threatening illnesses in individuals with weakened or compromised immune systems. The majority of people develop this illness by inhaling mold spores. Infection occurs less frequently when spores enter the body through a cut or an open wound in the skin.

Numerous factors, like poor hygiene, certain medications, and a compromised immune system, can increase your risk of mucormycosis. These factors include:

Risk Factors for Immunocompromised Patients

• Hematological malignancies (blood cancer)
• Hematopoietic stem cell transplantation
• Solid tumors
• Organ transplantation
• Malnutrition
• Premature birth
• High doses of corticosteroids or immunosuppressants
• Prophylaxis with voriconazole and deferoxamine therapy
• Rheumatoid disorders
• Multiple blood transfusions
• Increased serum iron load
• AIDS, renal failure, and liver disorders
• Uncontrolled diabetes with ketoacidosis and metabolic acidosis

Risk Factors for Individuals with a Normal Immune System

• Fight-related injuries
• Prolonged hospital stay
• Natural calamities
• Injection drug use
• Contaminated medical instruments
• Skin injuries, burns, and trauma

Risk Factors for Individuals Affected by COVID-19

Patients recovering from COVID-19 are at a higher risk of susceptibility to mucormycosis because:

• There is an alteration of innate immunity due to decreased T cells.
• Post-treatment, COVID-19 patients have increased levels of IL-2 R, IL-6, IL-10, and TNF-α, which contribute to immunosuppression.
• Administration of deferoxamine in patients with diabetic ketoacidosis can contribute to fungal growth.
• Corticosteroid therapy can lead to glucose imbalance.

If you experience any symptoms of mucormycosis, such as nasal congestion, nasal pain, fever, cough, or skin necrosis, consult a doctor immediately. The doctor might recommend further investigation if your symptoms fail to show any improvement post-treatment or if you experience symptoms such as swelling or internal bleeding.

The tests include:

1. Physical examination: As the first step, your doctor will physically examine you for signs of fungal infection. If they find any blackened tissue or suspect damage to the organs, they may order various diagnostic tests. Nasal endoscopy is used for the detection of rhino-orbito-cerebral mucormycosis.
2. Laboratory tests: Tests done to detect acidosis and iron load include:
   • Complete blood count (CBC): To detect neutropenia (decreased levels of white blood cells in the blood).
   • Blood glucose: To check for diabetes.
   • Bicarbonate and electrolyte: To detect hemostasis (the body's natural reaction to an injury that stops bleeding and repairs the damage).
   • Arterial blood gases (ABG): To determine the level of acidosis and direct corrective treatment.
   • Iron tests: To test the availability of iron mass, which has been shown to have high levels of ferritin and low iron binding capacity.
   • Other laboratory tests: Tests like staining using potassium hydroxide (KOH) and Calcofluor, fungal culture, and polymerase chain reaction (PCR).
3. Imaging tests:
   • Magnetic resonance imaging (MRI scan): An MRI is a diagnostic tool that uses a magnetic field and computer-generated radio waves to generate cross-sectional and high-resolution images of different body parts.
   • Computed tomography (CT scan): A CT scan combines a series of X-ray images taken from different angles to deliver high-quality cross-sectional images of different body parts. In rhino-sinus mucormycosis, CT is the investigation of choice to study the invasion of bone and soft tissue abscesses, and extension to the nervous system.
   • Biopsy: In a biopsy, a small piece of tissue is extracted from the affected organ. It is then sent to a laboratory to detect the presence of fungal infection or evaluate the extent of scarring and damage.

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1. Eat a well-balanced diet: Consuming a diet rich in vitamins and minerals will help strengthen your immunity and protect you from infections. Eating a diet low in processed and packaged foods, trans fats, and sugar may improve your symptoms and prevent the disease from worsening.
2. Wear masks: Mucormycosis is mainly contracted from spores present in the air. By wearing masks every time you step outside, you may be able to prevent dust particles or spores from entering your body. Additionally, wearing full-sleeved shirts and trousers while visiting dusty places may also prevent the fungus from coming in contact with your skin.
3. Maintain appropriate personal hygiene: Maintaining personal hygiene can go a long way in preventing mucormycosis. Wash your body regularly and promptly treat any cuts or scrapes on your skin.
4. Judicious use of steroids: Steroids have anti-inflammatory effects that can help control inflammatory and autoimmune disorders. However, their prolonged use is known to suppress immunity in the long term, making it easier for several fungi and bacteria to invade your body.
5. Use clean water for humidifiers in oxygen therapy: Oxygen therapy is a treatment that provides oxygen to people with breathing difficulties. If the water used for the treatment is unclean, it may increase the chances of inhaling mucormycosis-causing spores. Use pure water and clean the humidifiers regularly.
6. Use antibiotics/antifungals judiciously: Antibiotic and antifungal medicines are prescribed to fight various bacterial and fungal infections. However, their regular use may lead to resistance. Therefore, take these medicines only after consulting your medical provider.
7. Visit your doctor regularly: Regular check-ups are essential, especially for those with lifestyle or autoimmune diseases like diabetes, high blood pressure, or obesity. Contact your doctor if you have recently suffered from COVID-19 and notice any symptoms of mucormycosis.
8. Check your medicines: Certain medicines can act as immunosuppressants and lower your immunity. Consult your doctor to ensure that prescribed medications are suitable for long-term consumption and do not increase your risk of developing other illnesses.
9. Do not miss any signs and symptoms: Not all cases of blocked noses should be considered bacterial sinusitis, especially in immunosuppressed patients or those with COVID-19. Appropriate investigations should be carried out to detect fungal causes.

Prevention of Mucormycosis Associated with COVID-19

In hospitals:

• Ensure quality control of oxygen supply.
• Proper sanitization of oxygen cylinders.
• Preserve a hygienic hospital atmosphere.
• Use disposable oxygen humidifiers.
• Use clean distilled water in oxygen humidifiers and concentrators.
• Follow better risk messaging strategies.
• Proper use of medical checklists (like Mucor).
• Increase the number of testing facilities.
• Increase mass urine testing for diabetes.

Personal safety:

• Maintain personal hygiene during and post-COVID-19.
• Increase awareness during hospital discharge after recovery from COVID-19.
• Avoid self-medication and panic-driven practices.
• Judicious use of social media for health information.
• Wear barrier masks covering the nose and mouth.
• Get vaccinated for COVID-19.

The medications used to treat mucormycosis work by inhibiting its growth and spread. Some of the most common ways in which mucormycosis is treated are as follows:

• Intravenous antifungal medications: Depending on the severity of the infection, your doctor may begin intravenous administration of antifungal medications as soon as you are diagnosed with mucormycosis. In this treatment, an IV tube is introduced into your body, injecting high doses of antifungal medications directly into your bloodstream. You may be hospitalized for this particular treatment. Antifungal medications provided intravenously include amphotericin B and liposomal amphotericin B products (≥ 5 mg/kg).
• Surgical debridement: In this method, doctors surgically remove the affected tissue to stop the spread of infection to other body parts. This treatment may cause changes in the structure or shape of the affected area. In some cases, the surgical removal of the affected lung lobe or skin tissue has completely cured the infection without needing any other treatment. This is because the infection had not spread and was removed before it worsened.
• Oral antifungal medications: These medicines work by inhibiting the growth of cell walls in the fungus and eradicating them. It is essential to control the spread of infections to different body parts. Initially, the patient is provided with antifungal medications intravenously, but once the infection is under control, they are switched to oral antifungal medications. Examples of oral antifungal medications include posaconazole and isavuconazole.
• Immunostimulating drugs: A recent study reported the benefit of treatment with the checkpoint inhibitor nivolumab and interferon-Υ for an immunocompetent patient with extensive abdominal mucormycosis unresponsive to conventional therapy.

Management of Mucormycosis in COVID-19 Patients

To manage mucormycosis in patients with COVID-19, the following points should be considered:

• Make an early disease diagnosis.
• Do not miss early signs.
• Optimal and judicious use of systemic corticosteroids.
• Rational use of antibiotics.
• Supervised use of drugs that may increase infection risk.
• Maintain glycemic control.
• Classify according to possible, probable, and proven infection.
• Segregate patients based on COVID-19 disease status.
• Timely therapy initiation.

Home remedies for mucormycosis

Though mucormycosis is treated under medical supervision, here are a few home remedies that can be helpful in the management of mucormycosis. However, use them only after consulting your healthcare provider:

• Probiotics and yogurt (Dahi): Yogurt and other probiotics are high in beneficial bacteria, which can help prevent many fungal diseases. Fermented foods are also a good source of probiotics. If these don't work, consider taking probiotic supplements with higher concentrations of healthy bacteria.
• Tea tree oil: This is one of the most potent natural treatments for fungal infections due to its antifungal and antibacterial properties. Mix it with a carrier oil, such as coconut or olive oil, and apply it to the affected area three to four times a day.
• Coconut oil (Nariyal ka tel): Coconut oil, even in its unheated state, is an effective antifungal agent. Apply it three times a day to the skin of the affected area.
• Turmeric (Haldi): Turmeric has antibacterial and anti-inflammatory properties. It can be consumed orally with water or warm milk.
• Neem: Neem can be consumed as an oral supplement. You can also boil neem leaves in water for 2 to 3 minutes to make neem water, which has antimicrobial qualities and is beneficial for fungal-infected areas. A mixture of neem oil, chalmogra oil, and sesame oil in equal parts can also be applied to the infected area.
• Aloe vera: This is a well-known natural remedy for treating skin ailments. It not only heals the tissue but also calms the skin.
• Apple cider vinegar: Apple cider vinegar has antifungal activities. You can drink it by mixing two teaspoons in warm water or apply it to your skin with a cotton ball dipped in it. Doing this three times a day should yield positive outcomes.

Mucormycosis is a severe disease. If left untreated, it may lead to several long-term issues and even death. Some complications that may occur if mucormycosis is not addressed include:

• Brain infection: If the fungus spreads to the brain, it can cause a severe brain infection, which may result in brain hemorrhage or stroke.
• Paralysis: Mucormycosis infection may lead to paralysis of the body.
• Pneumonia: If untreated, mucormycosis can spread to the lungs and cause pneumonia.
• Hemorrhages: This condition occurs when a blood vessel in a specific organ ruptures due to infection. Untreated mucormycosis can spread to the brain, spleen, lungs, or heart, leading to hemorrhages.
• Seizures: A seizure is a sudden electrical activity in the brain that can result in uncontrolled muscle movements. The spread of mucormycosis to the brain may also lead to seizures.
• Death: In rare cases, mucormycosis can be life-threatening.

Mucormycosis is an aggressive, severe, and rare fungal infection that affects several COVID-19 patients. It is important to take greater care if you have a chronic illness.

If you suffer from mild mucormycosis, it can be treated immediately with antifungal medications. However, if the infection is chronic and has spread to different body parts, you may need to undergo surgery to manage the disease and prevent long-term complications, in addition to diet and lifestyle changes. Post-discharge from the hospital, if you are taking prescribed medications, it is wise to make timely visits to your doctor as advised.

Surgical management of mucormycosis may require complete debridement of infected tissue, which can lead to the loss of vital body parts. Rehabilitation of these defects can restore lost function and should be supported by occupational therapy.

Psychological issues can manifest as a result of surgical debridement for mucormycosis. The following measures can be taken to address these concerns:

• Routine preoperative counseling
• Inclusion of psychiatrists and clinical psychologists in the treating team
• Additional supportive psychotherapeutic sessions
• Assistance from support groups and others in managing the post-recovery phase

All these interventions can help improve overall quality of life. Try these 10 tips to keep yourself happy in difficult times.

Black Fungus vs Yellow Fungus vs White Fungus

Although used interchangeably, these three terms have different meanings:

1. Black fungus: Also known as mucormycosis, it is a fungal disorder characterized by the intake of mucor through the air or contaminated food or water. This infection causes the blackening of tissue in the affected area and is highly fatal.
2. Yellow fungus: Yellow fungus spreads through polluted settings and occurs when a patient inhales mold from the environment. It differs from both black and white fungal infections in terms of how it spreads. The yellow fungus attacks the body's internal organs and disrupts vital physical processes, causing far more severe damage. Therefore, individuals should begin observing its symptoms from the first day and seek medical advice.
3. White fungus: Candidiasis, often referred to as white fungus, is a fungal infection caused by Candida. This infection results in white creamy patches on the affected areas, hence the name.