Black Fungus Infection in COVID-19 Patients: Guideline For Management Of Mucormycosis

Mucormycosis or 'black fungus' infection may turn fatal if not cared for, stated an advisory prepared by the Union Health Ministry and ICMR. The guideline also listed dos and don'ts for mucormycosis management. Read here.

In the wake of the rising cases of mucormycosis or 'black fungus' infection among COVID-19 survivors, the central government on Sunday released an evidence-based advisory for screening, diagnosis and management of the disease. The guideline, prepared by the Union Health Ministry and ICMR, stated that mucormycosis is a fungal infection that mainly affects people who are on medication that reduces their ability to fight environmental pathogens. Sinuses or lungs of such individuals get affected after fungal spores are inhaled from air. It may turn fatal, if not cared for, the advisory said.

The advisory also listed warning signs and symptoms associated with this disease and include - pain and redness around eyes and nose, fever, headache, coughing, shortness of breath, bloody vomits and altered mental status.

Some factors that put Covid-19 patients at risk of developing the black fungus infection include uncontrolled diabetes mellitus, immunosuppression by steroids, prolonged ICU stay, malignancy and voriconazole therapy, the ICMR-health ministry advisory stated. Keep reading the

How to prevent black fungus infection

Mucormycosis or Black Fungus is a serious but rare fungal infection caused by a fungus named mucor, which is found on wet surfaces. Here are the preventive measures suggested by the ICMR-health ministry advisory:

• Use masks if you are visiting dusty construction sites.
• Wear shoes, long trousers, long sleeve shirts and gloves while handling soil (gardening), moss or manure.
• Maintain personal hygiene, including thorough scrub bath.

When to suspectblack fungus infection

A black fungus infection may be suspected in COVID-19 patients, diabetics or immunosuppressed individuals if they develop -

• Sinusitis nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone
• One sided facial pain, numbness or swelling.
• Blackish discoloration over bridge of nose/palate.
• 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.

Dos and don'ts for management of black fungus infection

For management of mucormycosis, the advisory suggested controlling diabetes, reducing steroids, discontinuing immunomodulating drugs, and extensive surgical debridement- to remove all necrotic materials. But no antifungal prophylaxis is needed, it stated. Here are some dos and don'ts COVID-19 patients should keep in mind for prevention and diagnosis of mucormycosis.

DOS

• Control hyperglycemia.
• Monitor blood glucose level post COVID-19 discharge and also in diabetics.
• Use steroid judiciously correct timing, correct dose and duration.
• Use clean, sterile water for humidifiers during oxygen therapy.
• Use antibiotics/antifungals judiciously.

DON'TS

• Do not miss warning signs and symptoms.
• Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators.
• Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology.
• Do not lose crucial time to initiate treatment for mucormycosis.

Treatment of black fungus infection

If you're diagnosed with black fungus infection, medical treatment may include installing peripherally inserted central catheter (PICC line), maintaining adequate systemic hydration, infusion of normal saline intravenously before Amphotericin B infusion and anti-fungal therapy for at least six weeks besides monitoring the patient clinically with radio imaging for response and to detect disease progression, the advisory noted.

Read the tweet from the ICMR -

Evidence based Advisory in the time of #COVID-19 (, & ) @MoHFW_INDIA@PIB_India@COVIDNewsByMIB@MIB_India#COVID19India#IndiaFightsCOVID19#mucormycosis#COVID19Updatepic.twitter.com/iOGVArojy1 ICMR (@ICMRDELHI) May 9, 2021