Black fungus among us

By Dr. Coco

August 30, 2022

Mucormycosis, known as “Black Fungus,” is a fungal infection that results in the nose becoming blackened or discolored. Other symptoms include blurred or double vision, chest pain, breathing difficulties and coughing up blood. Recently, it has caused over 2,100 deaths among COVID-19 patients in India, and over 11,000 confirmed cases. The disease, which is usually quite rare, has a mortality rate of around 54 per cent, according to the US Centers for Disease Control and Prevention. This rate is contingent on the condition of the patients’ health, as well as the body parts affected. Without immediate treatment using anti fungal medication and surgery to remove ensuing necrotic tissue, mucormycosis can easily be fatal.

The infection is closely linked to diabetes, and other conditions that cause the immune system to be compromised. Some experts believe that the overuse of certain immune system suppressing drugs could be behind India’s recent surge. An example of this is the steroid dexamethasone, which is used by intensive care doctors. One myth surrounding the fungal infection is that it is contagious, which it is not. It can not be spread from human to human contact, or human to animal contact. It can spread from fungal spores present in the air or environment, which are practically impossible to avoid.

The ensuing infection will then rapidly spread from the nose and sinuses to the face, jaw, eyes and even brain. The fungus blocks blood flow, killing infected tissue. It is then this dead, or necrotic tissue that results in the characteristic black discoloration of people’s skin. One professor, Malcolm Richardson, who is a professor of medical mycology at the University of Manchester in the United Kingdom, believes the name to be “totally inappropriate.” He shares this because the actual fungus is transparent, not black.

Generally, our immune system is able to fight off this particular fungi, but when paired with diabetes, COVID-19, and steroid treatment, a person’s immunity can be weakened to the point that these microorganisms can gain some traction. Some experts believe that the unsanitary conditions at some hospitals in India could heighten the risk of developing the infection. An ophthalmologist at Hinduja Hospital in Mumbai named Nishant Kumar is quoted as saying, “There is a lot of contamination in the pipes used for oxygen, the cylinders that are being used, the humidifiers used.” He continues by saying, “If you are immuno suppressed, and you have been on these pipes and oxygens for a long period of time, then these infections get much more of an opportunity to get in.” Strangely, other doctors and scientists do not agree with Dr. Kumar and consider this to be a myth, as black fungus cannot produce spores in fluid, and there is no evidence backing this.

Older studies on the infection that were published in 2014 and 2016 implicated hospital linens from poorly managed laundries as a source of the fungus spreading. Another 2009 review that researches hospital outbreaks list wooden tongue depressors, adhesive bandages, ostomy bags, and ventilation systems. One report from the University of Kentucky in Lexington believes that another route of transmission is the inhalation of spores that travel by dust from nearby buildings that may be under construction, or contaminated air-conditioning filters.

Opinions between experts are divided, however. SP Kalantri, who is a senior doctor and researcher at the Mahatma Gandhi Institute of Medical Sciences in Maharashtra has said, “Hospitals were dirty even before April. We need epidemiological studies to assess why these cases are rising now.” It’s important to also note that even before the pandemic, the prevalence of mucomycosis may have been around 70 times higher in India in comparison to the rest of the world.

One systematic review that took place in 2021 looked at all COVID-19-related cases of black fungus published in one scientific literature. Dr. Awadhesh Kumar Singh and his co-authors discovered 101 cases, with 82 of them in India and 19 from the rest of the world. Among the aforementioned cases, 31 per cent resulted in a fatality. The authors also reported that around 60 per cent of all the cases were actively infected with COVID-19, while 40 per cent happened post recovery.

Several myths surround the fungal infection, two we have already mentioned.

Another myth is that face masks can harbor black fungus. There is no evidence pointing to this. The last myth is that onions are to blame for the fungal infection. Again, a misattribution purported through social media. Possibly the most harmful myth is a video circling social media that claims a concoction of mustard oil, potash alum, rock salt, and turmeric can cure mucormycosis. However, as mentioned previously, the only treatments that are proven to work is surgery performed to remove necrotic tissue, along with the antifungal drug called amphotericin B. This has now ended in severe shortages of the drug in India.

Currently, there hasn’t been any news coverage on black fungus infection being discovered in America. Some tips to avoid possible exposure is wearing protective gear such as a mask when visiting dusty construction sites, along with long sleeved shirts and long pants. The Outlook India website is also urging people to wear gloves while handling garden soil, moss, or manure. Practicing good personal hygiene habits is always necessary, and calling a doctor in case any symptoms occur.