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Mucormycosis Among Cancer Patients: Who Are At Greater Risk For Black Fungus Infection?

Patients receiving chemotherapy and advanced stage cancer patients are also at risk for mucormycosis.

Patients receiving chemotherapy and those with advanced stage cancer are also at risk for mucormycosis or black fungus infection.

The Black fungus, also known as mucormycosis, has been a pre-existing disease even before the advent of COVID-19, though very few numbers were reported annually. People who are immunocompromised are more vulnerable to developing the black fungus infection. The patients reporting mucormycosis as a post-covid complication are largely the ones who have immunosuppressing conditions like an organ transplant history, uncontrolled diabetes, and cancer. These health conditions have predisposed the patients to this infection, said Dr. S M Shuaib Zaidi, Senior Consultant, Surgical Oncology, Indraprastha Apollo Hospital, New Delhi.

Among cancer patients, mucormycosis most commonly affects haematological cancer or more commonly known as 'blood cancer' patients and the bone marrow transplant recipients, according to Dr. Zaidi.

"Patients receiving chemotherapy and advanced stage cancer patients are also at risk for mucormycosis. Anybody suffering from or having recently recovered from cancer, if experiencing any of the symptoms suggestive of 'black fungus' should consult an Oncologist without delay as it is always better to be safe than sorry," he added.

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Why Black fungus is affecting COVID patients more?

The Black fungus or mucormycosis is affecting COVID patients more due to prolonged administration of steroids and subsequent immunocompromised state of health. It is reported more in patients who have diabetes, renal failure, cancer or who have undergone kidney/liver transplant and in patients who have been administered steroids for a long time, according to Dr. Zaidi.

"The viruses, as part of their replication cycle, suppress the immune system leading to the immune system not being able to clear /fight any other form of bacteria or fungi. The most famous example of this is HIV, of course, which causes long-term immune suppression. But other viruses do this on a much shorter timescale i.e., the immune system is only slightly suppressed for a few days or weeks while the virus is there," he explained.

Are you aware of the symptoms of Mucormycosis?

Patients suffering from the fungal infection typically have symptoms of stuffy and bleeding nose; swelling and pain in the eye; drooping of eyelids; blurred vision and in some cases loss of vision. There could be black patches of skin around the nose. Other possible symptoms include:

  • Headache
  • Double vision
  • Loosing teeth
  • Black patch on palate
  • Facial pain
  • Nasal congestion- brown colour discharge
  • Loss of vision or pain in the eyes
  • Swelling in cheeks and eyes
  • Black crusts in the nose
  • Coughing
  • Bloody vomits
  • Altered mental status

Mucormycosis in Covid patients: The mechanism of infection explained

As Dr. Zaidi stated, patients who have been on immunosuppressant drugs due to cancer treatments or organ transplants are more susceptible to this fungal infection. Other factors are usage of immune suppressant drugs, people who have undergone organ transplant, and even in severe covid cases. The expert further elaborated on Mucormycosis infection in Covid-19 patients. He said:

  • Severe viral infections are one of the causes which suppress the immunity. In COVID-19, the count of various white cells that are responsible for infection control and immunity gets altered which in turn makes a person more vulnerable to any kind of viral and fungal infections.
  • Serum creatinine levels, which is one of the important markers of pathology for COVID-19, is deemed to be another contributing factor. This is a form of iron which is otherwise stored in the cells and not allowed to flow freely in the blood stream. In COVID-19, the serum creatinine levels increase, which is the most favourable condition for a fungus to thrive. Hence the fungus mucor flourishes where there are high levels of serum creatinine present in the blood.
  • The condition of COVID-19 is a prethrombotic state that has proven to make patients vulnerable to blockage in vessels which in turn can cause damage to the tissue causing the fungus to thrive (hence a D-dimer test is done to check any irregularities here). These factors are based on previously acquired knowledge, general physiology on how patients for mucormycosis were treated and diagnosed in the pre COVID times.

"As studies and researches evolve, we might be able to elaborate on more concrete information," Dr. Zaidi noted.

Dr. Zaidi concluded: It is essential that people stay aware and concerned about mucormycosis. But not every covid patient is vulnerable to mucormycosis. Those who have been on immunosuppressant drugs and long-term steroids to protect them from any fatality need to be more cautious. People who have uncontrolled or unchecked diabetes and getting COVID care at home have been at more risk, as consumption of steroids to control COVID complexities has caused a spike in diabetes levels.

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