Mucormycosis is a fungal infection that mainly affects people who are on medication for other health problems, that reduces their ability to fight environmental pathogens.  

Mucormycosis — a rare form of fungal infection which could affect vision, and threatens life, if people do not get treated immediately after spotting its symptoms

It is akin to the fungus that develops on bread due to moisture if stored for long.

Sinuses or lungs of such individuals get affected after fungal spores are inhaled from the air, according to an advisory developed by National Task Force for COVID-19 and experts. 

Mucormycosis has to be suspected in COVID-19 patients, diabetics and immuno- suppressed individuals when they have sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone.

One-sided facial pain, numbness or swelling. Blackish discolouration over bridge of nose or palate. Parasthesia , Toothache, loosening of teeth, jaw involvement. Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar). Chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms 

Doctors pointed at link between indiscriminate use of steroids, high sugar levels, and activation of Black Fungi. 

According to Doctors,  major reasons for the exponential rise in cases among COVID patients is the excessive usage of steroids. 

Steroids are leading to extremely uncontrolled sugar levels, which make it a fertile field for the black fungi to grow, multiply and invade at a rapid rate.

Mucormycosis, as per the Centers for Disease Control, is a serious but rare fungal infection caused by a group of molds called mucormycetes. 

People with a compromised immune system can get mucormycosis when they come in contact with the fungal spores in the environment. 

There is a sudden and alarming increase in the occurrence of invasive rhino-orbito-cerebral mucormycosis in patients who have recovered from COVID recently 

It is treated with the anti-fungal amphotericin B, which is affordable, but is so toxic that we need to go in for more sophisticated options, that are also expensive.

Few more reasons are discussed by health experts are, the use of monoclonal agents like toclizumab may be contributory, besides the possible breach of sterile conditions that can lead to cross infections and hospital-acquired infections.   

Some other symptoms are stuffy nose, bloody, brown or black discharge from the nose, facial pain, numbness, swelling, and blackish colouration of skin. Apart from these, double vision, redness and bulging of the eyes are also signs. 

Mucormycosis is not contagious.

While only distilled water should be used for hydrating oxygen, sometimes tap water, or any other available water, is being used either due to ignorance or negligence. The containers are seldom cleaned, leading to concentration of viruses and bacteria in the piped supply system, 

The healthcare staff should watch the nostril area for black patches. A simple test by the bedside such as scraping the nostrils and dipping it in potassium permanganate solution can reveal the fungus. At this stage, the sight and life of the person can be saved.  While it is treated with antifungals, it may eventually require surgery. Doctors have said that it is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs. To maintain adequate systemic hydration, the treatment includes infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks.

Experts advise that you use masks if you are visiting dusty construction sites. Wear shoes, long trousers, long-sleeved shirts and gloves while handling soil (gardening), moss or manure. Maintain personal hygiene including a thorough scrub bath.  

Not just the mucormycosis , but other fungal infections such as candidiasis and aspergillosis have become increasingly common among intensive care units and Covid-recovered patients.  

The pathogens associated with mucormycosis varies considerably between India and developed countries . Globally, Rhizopus arrhizus is the commonest cause of mucormycosis.  The Apophysomyces species ranks second in India compared to the Lichtheimia species in developed countries.  Infections due to Rhizopus microsporus and Rhizopus homothallicus are rising in India. 

Due to the lack of regular health check-ups in the Indian population, the diagnosis of mucormycosis unmasked diabetes in 43% of patients from North India , 40% in Western India, and 24% in South India. 

 These data signify the need for regular health check-ups in the Indian population. 

 The situation is alarming in India, as the estimated diabetic population may rise to 101 million in 2030. Simultaneously, the expected rise of mucormycosis cases may worsen the condition. 

In India, 3–26% of mucormycosis cases are recorded from the immunocompetent host , compared to 18–19% globally.

Mucorales are thermotolerant saprophytic fungi found in decaying organic matter and soil samples. 

 An ecological study on Mucorales in Indian soils documented the isolation of pathogenic species such as Rhizopus, Lichtheimia, Cunninghamella, Rhizomucor, and Apophysomyces. 

 Similarly, aeromycological analysis in a community and hospital setting from India reported the isolation of pathogenic Mucorales in air samples. 

Rhizopus arrhizus is the most common agent causing mucormycosis in India and globally. However, the spectrum of agents causing this disease in India is considerably large. 

 The treatment of mucormycosis involves the early initiation of therapy, the surgical debridement of infected tissue, antifungal therapy, and managing the underlying disease. Amphotericin B (AmB) is the first-line drug of choice; subsequently, posaconazole and isavuconazole are prescribed. 

The major drawbacks in managing mucormycosis in India are a gap in treatment protocol and the financial constraints of patients that they cannot afford liposomal AmB.