Must identify Mucormycosis by name not colour of fungus: Dr Randeep Guleria

New Delhi: Mucormycosis is one of the general fungal infections being seen in recovering or recovered COVID-19 patients. The number of cases being reported is increasing, but it is not a communicable disease, meaning it does not spread from one person to another, like COVID-19 does. This was stated by Dr Randeep Guleria, Director, AIIMS, New Delhi, at a media briefing held at the National Media Centre, New Delhi.

Call it Mucormycosis and not Black Fungus Infection

Dr Guleria says it is better not to use the term black fungus while talking of mucormycosis, as it leads to a lot of avoidable confusion. “Black fungus is another family; this term got associated with mucormycosis due to the presence of black dots among the culture of white fungal colonies. In general, there are various types of fungal infections such as candida, aspergillosis, cryptococcus, histoplasmosis and coccidioidomycosis. Mucormycosis, candida and aspergillosis are the ones observed more in those with low immunity.”

Nature of infection, symptoms and treatment

Speaking about the prevalence of these infections, Dr. Guleria said: “Candida fungal infection can manifest with symptoms such as white patches in the mouth, oral cavities and tongue; it can infect private parts and can also be found in the blood (in which case it can become serious). Aspergillosis, which is relatively not common, affects and invades lungs by creating cavities in the lungs. What is observed in COVID-19 is mostly Mucormycosis; aspergillosis is observed occasionally, and Candida in some people.”

Speaking about the high-risk category of people who are being infected with Mucormycosis, he says: “90% – 95% of patients getting infected with Mucormycosis are found to have been either diabetic and/or taking steroids. This infection is seen very rarely in those who are neither diabetic nor taking steroids.”

He also mentioned that patients who are under high-risk category, i.e.  those having uncontrolled diabetes, and using steroids and COVID +ve with following symptoms should immediately report the same to their doctors. “Some warning signs for mucormycosis such as headache, rusting or bleeding from nose, swelling below the eye, lowering of facial sensation, if observed in high-risk patients or those taking steroids, need to be informed to doctors so that early diagnosis and treatment can be given.”

Types of Mucormycosis

Mucormycosis can be categorized depending on which organ of the human body it attacks.  Signs and symptoms of the infection also vary depending on the affected body part.

Rhino orbital cerebral Mucormycosis: It infects the nose, orbit of eye / eye socket, oral cavity and can even spread to the brain. Symptoms include headache, nasal congestion, nasal discharge (green colour), pain in sinus, bleeding nose, swelling on face, lack of sensation on face and skin discoloration.

Pulmonary Mucormycosis: This fungal infection affects the lungs. Causes fever, chest pain, cough and coughing of blood.

The fungus can also infect the gastrointestinal tract.

No definite link with oxygen therapy

“Many patients taking treatment at home, who were not on oxygen therapy, have also been found to get infected with Mucormycosis. So there is no definite link between oxygen therapy and catching the infection,” Dr Guleria added.

Treatment Challenges

Anti-fungal treatment goes on for many weeks, so it is proving to be challenging for hospitals, since COVID-positive patients and COVID-negative patients who catch mucormycosis need to be housed in separate hospital wards. Surgery also needs to be done judiciously since aggressive surgery for mucormycosis can have adverse outcomes for COVID patients.

Maintaining proper hygiene is very important for diabetic patients since chances of  opportunistic infection is very high in such patients. Those using Oxygen Concentrators should ensure cleaning of humidifiers regularly.