MUSBA HASHMI speaks with DR Rahul Bhargava to bring you a report on Mucormycosis, a rare fungal infection reported in COVID-19 patients

As if the second wave of COVID-19 wasn’t enough to make you shiver with fear, the country is reporting a rash of cases involving a fungal infection. Mucormycosis (sometimes called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds live throughout the environment. When someone breathes in these spores, infection in the sinus or lung can occur.

Mucormycosis can also develop on the skin after the fungus enters the skin through a cut, scrape or other type of skin trauma. Mucormycosis primarily affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.

“The symptoms associated with the disease include one-sided facial swelling, headache, nasal or sinus congestion, loss of vision or pain in the eyes, swelling in cheeks and eyes, fever and black crusts in the nose. The US Centre for Diseases Control and Prevention (CDC) estimates Mucormycosis with an overall all-cause mortality rate of 54 per cent,” Dr Rahul Bhargava, Head ENT & Neck Surgeon, Bhargava ENT & Gynae Clinic and Medical Consultant — ENTOD International, tells you.

Mucormycosis is affecting COVID patients more because of prolonged administration of steroids and subsequent immunocompromised state.

“Diabetic patients are at much higher risk of mucormycosis if affected by COVID-19 because Covid-19 further impairs their immune system and second, they are given corticosteroids for their treatment. This leads to a rise in their blood sugar level thus increasing their risk of mucormycosis. This combination of Diabetes and Covid-19, therefore, becomes a dangerous and deadly challenge to manage. Some cases of mucormycosis have also been observed in patients with an asymptomatic Covid-19 infection who were not even aware of their diagnosis,” Bhargava, who has come across three patients in past one week who have contracted this infection after recovering from COVID-19, explains.

A cause of worry is that presently, there are no feasible measures to prevent mucormycosis however, early detection is the best solution for now.

“Some of the things which can be done to prevent it are nasal douching and gargles with Betadine solution, proper control of Diabetes and using steroids only on prescription by a physician. Turmeric contains curcumin which is also good for fungal-infections,” he says.

Bhargava tells you that it is a serious infection and needs to be treated with prescription antifungal medicine, usually posaconazole, amphotericin B or isavuconazole.

“These medicines are given through a vein (amphotericin B, posaconazole, isavuconazole) or by mouth (posaconazole, isavuconazole). Other medicines, including voriconazole, fluconazole and echinocandins, do not work against  the fungi that cause mucormycosis. Often, mucormycosis requires surgery to cut away the infected tissue,” he adds.

The correlation between COVID-19 and Mucormycosis, Bhargava says, is not surprising at all. “Because the major risk factor for Mucormycosis is uncontrolled Diabetes mellitus which is also a high-risk factor for COVID-19. Secondly, steroids — which are known to suppress immunity — are the only of treatment, , like I have mentioned before, which has shown to decrease COVID-19 mortality. So, it is the combination of COVID-19, with decreased immunity and the steroids which probably predispose a patient to Mucormycosis,” he says.

Since the association between the deadly virus and mucormycosis is the state of weakened immune responses in patients, it depends from patient to patient when one can develop this infection. It may take days or even weeks after one has recovered from COVID to get infected with the fungus.