By: Dr S S Shirol
Black fungus or medically known as mucormycosis is not a new infection. This particular fungus is known to medical professionals for a long and has gained a lot of media and public attention due to the sudden increase in these cases in covid patients.
What is Mucor?
It is an uncommon fungus known as Mucorale, but emerging as an important fungal infection associated with a high mortality rate. It is the third most common infection after candida and aspergillosis. It spreads by local infiltration and is occasionally angioinvsive (meaning spreading into blood vessels) to become a disseminated disease.
How does it spread?
Most of the human infections occur by inhalation of fungal spores released in the air or inoculation into wounded skin or mucosa. These fungi are ubiquitous (meaning exist universally) in nature.
Who is prone to get infected?
Patients with compromised immunity like uncontrolled diabetes, cancer patients on chemotherapy, those on long term steroids, patients in ICU for a prolonged period are prone to this infection. However, its exact incidence and prevalence are not known.
How to prevent it?
Since the infection has gained attention and significance due to its occurrence in COVID19 patients let’s restrict to these cases only. The disease is associate with high mortality rates ranging from 50%-70% and the treatment is expensive and prolonged, associated with high morbidity. Hence prevention is better than cure.
The patients with the mild disease do not require steroids. Judicious use of steroids in moderate and severe disease, limiting the dose and duration of steroids, tapering at the earliest possible time as best judged by the treating physician along with good control of sugars in diabetics are key in reducing the chances of fungal infection. Good oral and nasal hygiene may help.
A high index of suspicion, early diagnosis and treatment will improve the chances of survival and reduce the disfigurement and loss of vision etc.
How to suspect?
A typical black patch/ redness/swelling appearing in and around the nose, eyes, mouth, palate, or signs of sinus infection in the high-risk patients should warrant the diagnosis of rhino-cerebral mucor. Don’t treat it as regular sinusitis in high-risk patients. The delay in diagnosis may lead to infiltration into the brain and increases the chances of death. Pulmonary mucor may present with breathlessness, chest pain, coughing out of the blood.
How to Treat?
The key to treatment and a good outcome are
1. Early diagnosis by clinical suspicion, aggressive biopsy, CT scan chest for pulmonary and MRI for rhinocerebral mucor
2.Good control of sugars and underlying predisposing condition if any.
3 Radical and aggressive debridement where required.
4. Prompt antifungal therapy with Liposomal Amphotericin B and Posaconazole.
What is the role of Plastic Surgeons?
The complexity of the structures involved in the debridement of the affected parts of the face leaves a defect and deformity which needs to be reconstructed once the disease is cured and the underlying disease is brought under control. Either a prosthesis or reconstruction with various flap surgeries may be required in the later part of the treatment.
Dr S S Shirol M.S, M.Ch, is a Cosmetic and Plastic Surgeon at Sampige Plastic Surgery Centre, Hubballi.