Written by: Dr. Shiva Murthy N. shivuindia@gmail.com / 8884328275)

CoVID-19 pandemic is around us since one and half year and currently it’s second wave of is going on. People of this country are finding it very difficult to tolerate it’s intensity and unfortunately many patients could not overcome the severity of the disease. Deaths due to CoVID-19 disease is very common especially in those who are having co-morbidities such Diabetes, Hypertension and other debilitating disease like Cancer and any other disease which needs use of steroids and other immunosuppressive agents.

Generally, commensals like some type of fungus, bacteria maintain symbiotic (means live and let live) type of relationship with the human body. This relationship will continue to be fruitful to each other as long as natural immunity of human body is intact. Steroids are commonly used as per the treatment protocol of CoVID-19. Steroids canusually produce adverse events like raise in blood glucose level and suppression of natural immunity etc. This can lead to uncontrolled growth of commensals (like Black Fungus (Mucormycosis) and other opportunistic bacterial infections (E.Coli)). Unfortunately, these commensals generally do not respond to commonly used antibiotics and milder antifungal drugs. In such conditions, stronger antibiotics and antifungals need to be used. These drugs too inturn have severe adverse events.

Unchecked growth of commensals can be dangerous as they can grow quickly and spread to adjacent tissues and organs. This can affect the vital functions and may lead to death. An example of such infection is Mucormycosis (commonly known as Black Fungus).

If diabetic patients with CoVID-19 infection use steroids then there is a chance for development of adverse events like uncontrolled/higher blood glucose levels and suppression of immunity. This inturn may allow growth of Black Fungus. In such situation mortality rate is increased by 50%.

Keeping the above facts in mind this article is written to educate the patients and their relatives to enable them to identify the Black Fungus infection and save the lives of their loved ones. Please go through the article and learn about the Black Fungus disease and learn to identify the disease early. If you find any signs or symptoms of Mucormycosis, contact your ENT surgeon immediately. They will be the better choice to identify the disease and advice you appropriately. Following are the commonly asked questions and answers to them:

1. Q. We are hearing more about outbreak of Black Fungus disease recently. Do you think this disease is going to trouble human life similar to CoVID-19 pandemic?

A: No. CoVID-19 is a viral disease and Black Fungus disease(Mucormycosis) is a fungal disease (which is a commensal, lives on our body on symbiotic relationship throughout our life). Both diseases are different and there is no relationship between these two diseases. Our body can control the growth of these commensals through natural immunity. If the natural immunity is compromised, then the commensals like Black Fungus, E.Coli bacteria can turn into trouble creators for human lives.

2. Q: If Black Fungus is a commensal then why is it making so much news in this CoVID-19 second wave?

A: Steroids are recommended for treating CoVID-19 disease as a part of treatment protocol. Natural immunity is suppressed and blood glucose level is increased by steroids as discussed above. If any diabetic patient gets infected with CoVID-19 disease, use of steroids can result in unusually high blood glucose levels and loss of natural immunity. Commensals may take undue advantage of this opportunity to grow and trouble human body. If appropriate measures are not taken to identify and treat this Black Fungus infection, mortality rate may be increased by 50%. Higher number of diabetic patients are undergoing treatment in ICU in the second wave and unfortunately more number of patients are suffering from Black Fungus infection at this point of time. Therefore, Black Fungus is making news during this CoVID-19 second wave.
3. Q: Is the Black Fungus disease a new disease?

A: No. Black Fungus disease is an old disease. As discussed in question 1, Black Fungus lives on the human body as a commensal. If the natural immunity is intact and blood glucose levels are under control, then it will not trouble you and also will not infect the tissues and organs. Diabetic patients should be careful if they are suffering from CoVID-19 infection and steroids are used as per treatment protocol. They should keep a watch on blood glucose levels and immunity. If care is taken, then Black Fungus infection can be prevented.

4. Q: During CoVID-19 first wave, patients did not suffer from Black Fungus infection. It was not at all in the news. Why did it surface now?

A: As per reports, during CoVID 19 wave one, less number of patients suffered from Black Fungus disease. But in the second wave significantly high number of patients are suffering from Black Fungus disease. Reasons may be many such as high number of diabetic patients with CoVID-19 are treated in ICU, unchecked use of steroid in these patients, derailed blood glucose control and also it is suspected that, use of low quality water while preparing oxygen cylinders due to unexpected high demand for such cylinders. Whatever may be the reason, patients with Black Fungus disease should be identified as early as possible and treatment should be initiated early to save their lives.
5. Q: What are the signs and symptoms of Black Fungus disease? How to identify Black Fungus is taking upper hand over my natural immunity?

A: Signs and symptoms of Black Fungus disease are blood stained watery nasal discharge, nasal block (one side or both sides), difficulty in respiration, swelling over face, swelling of eyes and its surroundings, pain in eyes, headache, symptoms are increasing in severity time to time, rapidly changing severity in a matter of hours, loss of sight (one side or both sides), worsening health status and oxygen saturation etc. If you notice any of these signs and symptoms, report to your ENT doctor immediately. They will do further investigations to confirm the disease. If they feel immediate medical treatment and surgical treatment required, then do not hesitate. Cooperate with your doctor to. Do not try self medication. It can cost your life.

6. Q: Why should we worry about Black Fungus? What are the problems that can be caused by the Black Fungus once it starts invading human body?

A. As long as natural immunity is strong, Black Fungus cannot invade into the organs of human body. Once the natural immunity is reduced due to diabetes, high blood glucose or use of drugs like steroids, immunosuppressors etc, in such situations, Black Fungus can start invading into the tissues. It can start invading from nose, sinusus, then spread to upper teeth, eyes and then later to the brain. The signs and symptoms of the invasion of Black Fungus are already discussed in Q 5. If you start seeing these signs and symptoms, and if the health status starts worsening, it is important to inform your doctors and take their help to identify the disease at the earliest. This can help in saving your life.

7. Q: Black Fungus is having higher mortality rate. Is it correct? If we need to prevent death, what should we do?

A: Yes. If Black Fungus infection is noticed in any patient, mortality is increased by 50% in such patients. Therefore, quick action is required after noticing signs and symptoms of Black Fungus infection. If the actions are taken within 24-48 hrs, then 70 to 90% of the infected patients lives can be saved. Generally, the infection starts with nose and then it spreads to adjacent tissues and organs such as sinusus, teeth, eyes and lastly to the brain. Parts affected by Black Fungus should be removed from body by doing surgeries on emergency basis. In addition to surgery, medical treatment with Amphotericine B drug also needs to be done.

If the infection is extended to the brain, then we may not be able to save the patient. Therefore, it is important to take action as early as possible. Do not try self medication and don’t waste time at home. If you notice any signs and symptoms of Black Fungus disease, contact ENT surgeon or your family Physician for further advice and action.

8. Q: Is there any relationship between CoVID-19 disease and Black Fungus disease? Do you think all CoVID-19 patients are susceptible for Black Fungus infection?

A: No. As told earlier there is no relationship between CoVID-19 disease and Black Fungus disease. Both are entirely different. CoVID-19 is a viral disease. Black Fungus is an opportunistic infection. Black Fungus infection generally occurs whenever patient’s immunity is low. Generally, CoVID-19 is treated with steroid drugs. Steroids are known to reduce immunity. Steroids also increase blood glucose levels. Fungus generally grows well in the presence of conducive environment like high blood glucose levels and reduced natural immunity. If any patient is already a Diabetic and contracts CoVID-19 infection, in such conditions use of steroids can derail the blood glucose levels from control and increase the chances of contracting Black Fungus infection.

9. Q: What are the treatment options available for Black Fungus? Can self medication cure the Black Fungus disease?

A: As mentioned earlier, one should not waste time in self medication. If you recognize any signs and symptoms of Black Fungus infection, then immediately you should ask for ENT surgeon’s or Medical doctor’s help. Doctors may adopt two types of treatment methods such as medical treatment and surgical treatment.

Immediately after identification of Black Fungus infection, doctors may initiate the treatment with Amphotericine- B drug. There are two types of formulations available namely Lyophilized Amphotericine- B formulation or Liposomal Amphotericine- B formulation. Liposomal formulation is more effective and having fewer side effects. Therefore it is always preferred. But cost of treatment can be more. If the pharma companies agree to cooperate and reduce the cost of medication, especially in this pandemic situation, then it can really help the patients. If the patient cannot afford Liposomal Amphotericine- B, then Lyophilized formulation can be used. Treatment with Amphotecine-B should be initiated within 24-48 hours of diagnosing Black Fungus infection.

Simultaneously, surgical treatment should also be initiated to save the patient’s life. Infected parts of the body need to be removed by conducting appropriate surgeries as early as possible. It is also important to prevent further spread of infection to the brain. Generally, group of specialists (ENT,Dental, Ophthalmology and neurosurgery) need to work together for obtaining successful results as multiple organs are infected.

10. Q: What are the adverse effects of Amphotericine-B? Is this a new Drug?

A: Amphotericine – B is not a new drug. It is an Antifungal Drug. It is having many adverse events affecting vital functions. Therefore, generally this drug is not used for mild to moderate fungal infections. Amphotericine B is reserved for severe form of fungal infections. It’s use is considered only when benefits are justified over risks. It can produce three important adverse events such as: 1.Nephrotoxicity:This can be prevented by using good amount of IV fluids. 2. Alteration of electrolytes levels especially hypokalemia (low potassium levels in blood). This can be treated by using IV fluids and monitoring electrolyte levels in blood. Also, supplementing the electrolytes in food and oral fluids can be useful. 3. Anemia: this can be treated by giving blood transfusion and intake of nutrients which can increase the production of red blood cells and other components of blood. Patient may suffer from other adverse events too. Doctors need to observe these and take corrective actions accordingly.

11. Q: What are the precautions to be taken during second wave of CoVID-19 pandemic situation?

A: As discussed above, patients who were treated in hospital for CoVID-19 disease should be under watch for signs and symptoms of Black Fungus. If they notice any signs and symptoms, qualified medical doctors should be contacted immediately. Take care of blood glucose levels and ensure diabetes is under control.

In addition to this, take general precautions to prevent the spread of CoVID-19 infection. Wearing mask, washing hands, using sanitizers, maintaining social distance, maintaining hygienic practices like not touching eyes, nose, mouth repeatedly, not attending mob meetings, avoiding programs where large number of individuals are expected to be assembled, not visiting hospitals for trivial reasons etc. Take online/Tele-consultations as much as possible to avoid hospital visits for minor health issues. Hospitals are known to spread infections as many patients with severe diseases are treated there. (Note: Doctors are trained to take precautions and maintain practices to avoid such infections.) Maintain good nutrition by eating good food which is healthy and nutritious. Include variety of vegetables, fruits, eggs, and meat to make it more nutritious. Avoid junk food and oily food. Do not worry unnecessarily. Anxiety can alter physiological status and make it more susceptible to infections and other diseases. Do exercise regularly and take CoVID-19 vaccine if not vaccinated. Follow the above mentioned healthy practices as much as possible to keep yourself safe from any kind of infections for that matter.