With the recent surge in numbers of COVID 19 cases, doctors across India have started seeing an alarming rise in other associated infections that prey on the weakened body. Of all these, perhaps the deadliest is one known as “the black fungus” or Mucormycosis.
This rare disease was previously seen almost exclusively in Diabetics (60%), with chronic kidney failure (17%), blood cancer (11%) and patients on chemotherapy (12%). However, patients recovering from COVID 19 infections often have a combination of Diabetes; high dose steroids use for treatment and a weakened post viral immune system and thus are prime targets for the fungus
The deadliness of the disease arises from three facts:
1. Extremely subtle early stage: Often presents with nothing but nasal fullness, or fever that just cannot be controlled, along with high blood sugars. Moreover, due to the rarity of the disease, it can often be missed by patients and clinicians alike.
2. Rapid progression: Just like bread mold, the fungus once established spreads rapidly, and can cause death and/or blindness within 24-48 hrs and in up to 90% cases within 7 days. Once the fungus spreads into the orbit or brain, chances of recovery reduce from 90% to 45% and 17% respectively.
3. Difficult to treat: The fungus kills off the blood vessels very early, and then feeds on dead tissues. This unfortunately means that irrespective of dosage, any medication cannot reach the fungus due to no blood flow in the infected area.
The fungus needs to be diagnosed and treated early to be controlled. It is critical to visit an experienced clinician at the earliest, due to the rapidity of fungal spread and the high mortality rate.
- Fever more than 48 hrs.
- Nasal obstruction, bleeding, crusting
- Decreased or blurry vision, swelling or redness of eye
- Black eschar on roof of mouth
Nasal endoscopy and biopsy
CT and MRI of the face
Serum Galactomannan assay, and fungal DNA
Control of immunosuppression
Removal of dead tissue
Antifungals (IV and topical)
Prevention: Post COVID patients
Identify High Risk (Diabetes, Kidney disease or elevated creatinine, steroid treatment >15 days, High viral Load on diagnosis)
- Use Saline nasal drops frequently
- Check Blood glucose daily (>300 mg/dl increased risk)
- Check color vision (identify red, blue and yellow) and eye movements daily
- Avoid xylometazoline (Otrivin) nasal drops
- Stop Flonase or other steroid nasal sprays
- Consider holding steroid inhalers for 1 week
- Early ENT consult if any suspicious changes noted
Blog Written By
Apollo Spectra Hospitals, Bengaluru