Facts about mucormycosis

A monitor screen shows yellow fungus infection in a patient during an extended functional endoscopic sinus surgery on a black and yellow fungus infected patient, at a hospital in Ghaziabad on May 28.

What is mucormycosis

Mucormycosis is a serious but rare fungal infection caused by a group of molds or fungus called mucormycetes. There are five major clinical forms. The most common ones affect the nasal sinuses or the lungs, but can also affect the skin after a cut, burn or other type of skin injury. A classic clinical sign of mucormycosis is the rapid onset of tissue death and blood clotting (black dead tissue) with or without fever.

Where do they occur

These molds live throughout the environment in soil and their spores can be found in the air. Health care-associated outbreaks have been linked to adhesive bandages, wooden tongue depressors, hospital linen, negative pressure rooms, water leaks, poor air filtration, non-sterile medical devices and building construction.

Who is vulnerable

Persons with uncontrolled diabetes; malignancy; transplant recipients; prolonged corticosteroid therapy; skin trauma, burns, or surgical wounds; iron overload; intravenous drug use; malnourishment; and premature infants.

Mucormycosis mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.

How is it transmitted

Transmission occurs through inhalation, inoculation, or ingestion of fungal spores from the environment. A definitive diagnosis of mucormycosis typically requires microscopic evidence or positive culture from a specimen from the site of infection. The diagnosis is mostly based on the presentations and symptoms, detailed patient history and a thorough clinical evaluation, accompanied by laboratory tests. A sample of the tissue from the affected site can show the presence of the fungus, and the sample may include fluid from the respiratory system or a small sample of the skin tissue. Polymerase chain reaction, or PCR, test is available to make the diagnosis and in some patients a CT scan will be required, especially if the infection is deep-seated within the lungs or brain.

Treatment

Early recognition, diagnosis, and prompt administration of appropriate anti-fungal treatment are important for improving outcomes for patients. Surgical removal of infected tissue is often necessary. Control of the underlying immunocompromising condition should be attempted when possible.

The primary drug for treatment is a fungal medication called Amphotericin B. Amphotericin B is not an unfamiliar drug for clinicians at least in States such as Uttar Pradesh, Bihar and West Bengal where this drug has been used for years to treat another life-threatening disease called visceral leishmaniasis, or Kala Azar (known as “black fever”). With the advent of more safe medications like the expensive Liposomal Amphotericin B (LAMB) injection and the oral drug Miltefosine (which cannot be used during pregnancy), Amphotericin B has been used less for treating Kala Azar. However, in addition to the use of anti-fungal medicine, an important factor that determines the successful outcome of the treatment is the reversal of the underlying condition. In the case of COVID-19, the delay and challenges in obtaining treatment and indiscriminate use of medications such as steroids facilitate mucormycosis infection.

 

Survival rate

The overall prognosis depends on several factors, including the rapidity of the diagnosis and treatment, the site of infection, and the patient’s underlying conditions and degree of immune-suppression. The overall mortality rate is approximately 50 per cent.