• Mucormycosis, also known as black fungus, which is primarily affecting people recovering from COVID-19, has been declared an epidemic in Rajasthan.

• Currently, the state has around 100 black fungus patients and a separate ward has been made at Sawai Man Singh (SMS) Hospital in Jaipur for their treatment.

• Mucormycosis has been notified as an epidemic and a notifiable disease in the state under the Rajasthan Epidemic Act, 2020.

• Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.

• Cases of mucormycosis are on a rise in many states in India.

• The Telangana government has declared mucormycosis as notifiable disease under Epidemic Diseases Act, 1897.

• As many as 90 people have died of mucormycosis in Maharashtra. More than 200 patients of mucormycosis were detected in the last one week and the state government has urged the Centre to increase the supply of Amphotericin-B injection which is used in its treatment.

• A COVID-19 recovered patient died of black fungus infection, the first such case reported in Assam, at a private hospital in Guwahati on May 19.

• In Kerala, a COVID-19 recovered patient in Tirur, had to have one eye removed by doctors after he was infected with black fungus.

• According to experts, people with diabetes are more prone to getting the black fungus infection.

• The Indian Council of Medical Research (ICMR) has released an advisory for screening and management of the disease.

What is mucormycosis?

• Mucormycosis (sometimes called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These fungi live throughout the environment, particularly in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood.

• People get mucormycosis by coming in contact with the fungal spores in the environment. For example, the lung or sinus forms of the infection can occur after someone breathes in spores. 

• These forms of mucormycosis usually occur in people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. 

• Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air.

• Mucormycosis can also develop on the skin after the fungus enters the skin through a cut, scrape, burn, or other type of skin trauma.

• The fungal infection being found in COVID-19 patients with uncontrolled diabetes and prolonged intensive care unit (ICU) stay, may turn fatal if uncared for, ICMR said. 

Symptoms

Warning symptoms include:

• Pain and redness around eyes and nose

• Fever

• Headache

• Coughing

• Shortness of breath

• Bloody vomits

• Altered mental status.

In COVID-19 patients with diabetes and immuno-suppressed individuals, one must suspect of mucormycosis if there is:

• Sinusitis — nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone.

• One-side facial pain or numbness or swelling.

• Blackish discoloration over the bridge of the nose or palate.

• Toothache.

• Blurred or double vision with pain, skin lesion, thrombosis & necrosis (eschar).

• Chest pain and worsening respiratory symptoms. 

Major risk factors for this disease include uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, malignancy and voriconazole therapy.

To prevent the disease

• Blood glucose level should be monitored post-COVID discharge and also in diabetic patients. 

• Steroids should be used judiciously in correct timing, dose and duration.

• Clean sterile water should be used in humidifiers during oxygen therapy.

• Antibiotics and antifungal medicines should be used correctly.  

Medical treatment

It includes:

• Installing peripherally inserted central catheter.

• Maintaining adequate systemic hydration.

• Infusion of normal saline intravenously before Amphotericin B infusion.

• Anti-fungal therapy for at least six weeks besides monitoring the patient clinically with radio imaging for response and to detect disease progression.

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