All about Black Fungus (Mucormycosis)

What is Mucormycosis or Black Fungus infection?

Black fungus disease, also known as mucormycosis, is a rare but dangerous fungal infection. It aggressively affects the nose, eye, and sometimes the brain. The black fungus is especially dangerous if left untreated, as it can cause mutilating damage and even disfigurement, loss of vision, and serious brain infection. 

While it is a very serious illness, mucormycosis fungal infections can be life-threatening in diabetic or people with compromised immune systems.

Mucormycosis or black fungal infections are caused by a group of fungi or molds that are called “mucormycetes”. They are found throughout the environment, especially in soil, plants, manure, air, and decaying organic matter. 

Some examples of the types of fungi that commonly cause mucormycosis are:

• Apophysomyces species, Mucor species, Rhizopus species, Rhizomucor species, Syncephalastrum species, and Lichtheimia (formerly known as Absidia) species

It is possible to catch black fungus when the spores are inhaled into the lungs or, when the spores enter a person’s skin through a cut, a burn, or any other type of skin trauma.

Is it harmful?

People come into contact with these mucormycetes every day, and they are generally not harmful to most healthy people. 

However, for those who have weakened immune systems, or medical conditions such as diabetes, when they breathe in these fungal spores, it can lead to an infection in the lungs or sinuses. This, in turn, can spread to other parts of the body.

How does mucormycosis spread?

In most cases, mucormycosis or black fungal infection is spread through fungal spores floating in the environment that are then inhaled. 

In home and hospital environments, it can be spread by:

• Air humidifiers
• Oxygen tanks with dirty water
• Damp and moist rooms, especially water-damaged buildings

There are different types of mucormycosis, or black fungus infections, based on which parts of the body are infected. 

• Rhinocerebral (sinus and brain) mucormycosis: is when the infection starts in the sinuses and can spread to the brain. It is most common in people with diabetes.
• Pulmonary (lung) mucormycosis: this is when the infections are mostly in the lungs, and is common in people with cancer, those who have had organ transplants, or a stem cell transplant.
• Gastrointestinal mucormycosis: is when the infection affects the gastrointestinal tract. It is common in infants, and those who have had antibiotics, surgery, or any medications that affect the immune system.
• Cutaneous (skin) mucormycosis: this is caused when the fungi enter the body through a break in the skin and is common even among people who don’t have weak immune systems.
• Disseminated mucormycosis: is when the black fungus infection spreads to different parts of the body through the bloodstream, affecting organs like the brain, heart, or spleen.

The common general symptoms associated with black fungus infections include:

• Headache
• Cough 
• Facial swelling and pain
• Loss of vision or pain in the eyes
• Fever
• Nasal congestion
• Sinus pain
• Black lesions

However, different types of mucormycosis infections might present different symptoms, as they depend on where in the body the fungus is growing:

Rhinocerebral (sinus and brain) mucormycosis:

• Facial swelling, especially around the eyes
• Headaches and eye pain
• Nasal or sinus congestion
• Difficulty chewing or opening the mouth
• Affected vision (double vision, loss of vision, difficulty opening or closing the eyes)
• Black lesions on the nose or mouth
• Black discharge or blood from the nose.
• Fever

Pulmonary (lung) mucormycosis:

• Fever
• Cough
• Chest pain
• Shortness of breath

Gastrointestinal (stomach and intestines) mucormycosis:

• Abdominal pain
• Nausea 
• Vomiting
• Gastrointestinal bleeding

Cutaneous (skin) mucormycosis:

• Blisters or ulcers
• Blackened skin tissue
• Excessive redness or swelling around a wound
• Fever

While mucormycosis is generally a very rare infection, more and more cases are being seen (especially in India) during the COVID-19 pandemic. 

The infection can be very serious as it affects the sinuses, the brain, and the lungs. Additionally, it can be life-threatening in severely immunocompromised people. Black fungus infections spread quickly through the body, and if left untreated, can spread to the lungs or the brain. This can cause brain infection, paralysis, a coma, seizures, and eventually death. 

According to the CDC, mucormycosis has a mortality rate of 54%.

Who is at higher risk for black fungus infections?

We have already mentioned that people who have health problems, or compromised immune systems are at a higher risk from black fungus infections. These include:

• People with diabetes
• People with cancer
• People with HIV/AIDS
• Those who have had an organ transplant
• Those who have had a stem cell transplant
• People who take medicines that affect the body’s ability to fight germs and sickness
• People with COVID-19
• People who have used corticosteroid for a longer period of time

People who have or are recovering from COVID-19 are often seen to be at a higher risk for black fungus infections. They often develop symptoms within 6 weeks of infection.

Doctors also believe that the increase in mucormycosis infections may be connected to the use of steroids to treat severe and critically ill COVID-19 patients. In such cases, steroids are often used to reduce inflammation in the lungs. 

There is some evidence that steroids help stop some of the damage that may be caused by the body’s own immune system. This is because when the immune system fights off the coronavirus, it can go into overdrive and end up fighting other parts of the body as well.

Unfortunately, these steroids also reduce immunity, which makes people more susceptible to these infections. 

People with pre-existing diabetes are at additional risk. Diabetes is already associated with a reduced immune response, and the use of steroids can push up blood sugar levels, creating more ideal conditions for the spread of mucormycosis.

In most mild cases, black fungus infections are treated with antifungal medicines. 

However, if the fungus has spread to the other organs, such as the eyes or the brain, a more multi-discipline approach is required to treat it. Depending on the parts of the body that have been infected, microbiologists, internal medicine specialists, neurologists, ENT specialists, ophthalmologists, dentists, and surgeons might become involved. 

All the infected tissue needs to be surgically removed, leading to some patients losing an eye/or part of their jaw. Following this, patients might require a cycle of intravenous antifungal treatment for four to six weeks.

DISCLAIMER: The details provided in this article are for informational purposes only and are not a substitute for advice from a registered medical professional.