Have you ever heard of this 'black fungus'? Maybe you heard it in a newspaper or on TV news. It's actually a scary and potentially serious disease. Today, let's talk about this fungal infection, medically known as Mucormycosis, in simple terms.
What is Mucormycosis?
Simply put, Mucormycosis is a very serious fungal infection . It is caused by a group of fungi called mucormycetes. These fungi can affect many different parts of our bodies. For example, it can affect your eyes, sinuses (the spaces in your forehead and cheeks), brain, lungs, stomach and intestines (gastrointestinal tract), or skin.
In this case, the symptoms vary depending on which part of your body is affected by the fungus. It is sometimes called zygomycosis.
Now imagine, these fungi called mucomycetes live in the environment around us, especially in soil, compost, decaying leaf litter, and wood chips. But surprisingly, most of us do not get sick from these fungi. However, people with diabetes, certain types of cancer, or other conditions that weaken the immune system are at higher risk of developing mucomycosis.
The most important thing is that mucormycosis is a disease that can often be fatal . Therefore, if you have these symptoms, you should definitely go to the hospital or seek medical advice immediately.
What are the main types of Mucormycosis?
There are several main types of mucormycosis. They are:
- The type that affects the nose, eyes, and brain (Rhino-orbital-cerebral or Rhinocerebral mucormycosis)
- Pulmonary mucormycosis
- Cutaneous mucormycosis
- The type that affects the digestive system (Gastrointestinal mucormycosis)
- Disseminated mucormycosis
What are the symptoms of this disease?
The symptoms of mucormycosis depend on which part of your body is infected. You may experience symptoms in your nose, lungs, digestive tract, around your eyes, or on your skin.
The type that affects the nose, eyes, and brain (Rhino-orbital-cerebral Mucormycosis)
This is the most common type of mucormycosis . In this case, the fungus first infects your sinuses and can spread to the orbit and brain. It is especially common in people with severe, uncontrolled diabetes (for example, an A1C of more than 8% despite regular treatment for more than a year) and in people who have had organ transplants.
Symptoms of this type are:
- Fever
- Headache
- Sinus pain (pain in the forehead, cheeks)
- Nasal congestion
- Sores or ulcers on the roof of the mouth
- Loss of vision or double vision
- Difficulty turning the eyes and smiling (this is called `cranial nerve palsy`)
- Protruding eyes (proptosis)
- Swelling around the eyes
- Black tears or pus from the eyes
- Confusion or other mental changes
Pulmonary Mucormycosis
This fungal infection of the lungs is the second most common type. It is most common in:
- People with blood-related cancers (e.g., leukemia, lymphoma, or myeloma), especially those with low levels of certain white blood cells (neutropenia)
- For those who have had a bone marrow transplant
- For those who have had a solid organ transplant
Symptoms of this type:
- Fever
- Chest pain
- Difficulty breathing (dyspnea)
- Coughing up blood (hemoptysis)
Cutaneous Mucormycosis
This type of infection occurs when a fungus enters your skin through a cut or scratch. Imagine that you have a small wound and something like dirt gets on the wound. This can cause this fungus to enter. Surprisingly, this type is also common in people with healthy immune systems.
Skin symptoms:
- Painful blisters, sores, or hard lumps on the skin
- Skin redness, discoloration, or swelling
These skin changes get worse over time. They turn black, spread over large areas, and can sometimes extend into the muscles or bones.
The type that affects the digestive system (Gastrointestinal Mucormycosis)
This is an infection of the stomach or intestines. It is most common in premature babies. But recently, it has also increased in adults with low immunity (neutropenia), people taking long-term corticosteroid medications, and people with other diseases that weaken the immune system.
Symptoms:
- Stomach pain
- Nausea and vomiting
- Gastrointestinal bleeding
Disseminated Mucormycosis
In this case, the infection spreads through the blood to various parts of the body. It most commonly affects the brain, but it can also affect the heart, spleen, or skin. This is the most severe and deadly form of mucormycosis. It is most commonly seen in:
- People with blood-related cancers, especially those with neutropenia
- People who have had a bone marrow transplant
- People who have had a solid organ transplant
Because this type affects many parts of the body, symptoms of the other types mentioned above may also appear, as well as symptoms of any underlying medical conditions you may have.
Why does Mucormycosis occur?
Mucomycosis is caused by a variety of fungi. The most common are Rhizopus oryzae and Rhizopus delemar. (These are specific types of fungi.) These fungi live in the environment - especially in soil, compost, decaying leaf litter and wood chips. They can also be found in food that has not been washed properly. Most of us do not get sick from breathing in or touching these fungi. But if you have certain health conditions, your immune system may not be able to fight off the infection.
How does this get to us?
You can get mucormycosis by breathing in the spores (reproductive parts of the fungus) of these fungi, eating something that has them, or getting them through a break in the skin. These spores are so small that we can't see them or avoid them.
Rarely, it has been transmitted from hospitals, through contaminated medical equipment, and after natural disasters. For example, severe tornadoes can stir up large amounts of soil and release the fungus into the air.
Is this contagious from person to person?
No. Mucormycosis is not spread from one person to another. You can only get this fungus from the environment.
Who is at higher risk of developing mucormycosis?
People with diabetes and certain medical conditions that weaken the immune system are at the highest risk of developing this condition. Also, having too much iron in the body can contribute to this. Risk factors include:
- Diabetes mellitus, especially with conditions such as hyperglycemia and ketoacidosis.
- Having had a solid organ transplant.
- Having had a hematopoietic stem cell transplant (bone marrow transplant).
- Neutropenia is a decrease in white blood cells called neutrophils.
- Cancer, especially leukemia, lymphoma, or myeloma.
- Long-term use of corticosteroid medications.
- Injecting drugs without medical advice.
- A condition called hemochromatosis (which increases the amount of iron in the body - `iron overload`).
- Burns or severe skin injuries that allow dirt and germs to enter the wound.
- Being born prematurely or having a low birth weight.
Simply put, if your body's disease-fighting system (immune system) is weak, you are more likely to develop this.
What are the possible complications of this disease?
Mucormycosis can cause devastating and life-threatening complications, including:
- Cavernous sinus thrombosis: This is a blood clot that forms in your sinus cavities. It can be fatal.
- Necrotizing fasciitis: This is a severe, rapidly spreading bacterial infection (also known as "flesh-eating bacteria"). It can be fatal.
- Osteomyelitis: This is an infection of your bones. The bones can be destroyed.
These are really dangerous conditions, which is why it's important to get treatment quickly.
How do you accurately diagnose this disease? (Diagnosis)
A doctor may suspect mucormycosis based on your symptoms and other medical conditions you have. To confirm this, they will take pictures (imaging) of the affected body parts and examine your body tissues for the presence of fungi.
Tests for this:
- Imaging: Chest X-rays, CT scans (computed tomography scans), or MRI (magnetic resonance imaging) scans may be done.
- Endobronchial ultrasound: This is a type of bronchoscopy. This means that an ultrasound device attached to a thin, lighted tube is used to take pictures of the inside of the lungs.
- Tissue biopsy: A doctor can look at your tissue under a microscope or through lab tests to see if mucormycosis fungi are present.
How is Mucormycosis treated?
Doctors treat mucormycosis with antifungal medications. They may also need to perform surgery to remove infected or dead tissue. The antifungal medications used for this are:
- Amphotericin B
- Posaconazole `(Posaconazole)`
- Isavuconazole
You will need to take this antifungal treatment for weeks, maybe months.
Can this disease be completely cured?
Yes, it is possible. But it needs to be treated quickly. Even if treatment is delayed for a few days, the chances of survival can be greatly reduced. Even if treatment is started quickly, it can be difficult to cure.
Quick treatment is the best chance of saving a life!
What is the mortality rate due to Mucormycosis?
Because it is difficult to treat and because many people with mucormycosis have weakened immune systems, the mortality rate is high. The mortality rate for all types of mucormycosis is about 54%. Mucormycosis that affects only the sinuses has a slightly lower mortality rate (about 46%). However, disseminated mucormycosis that has spread to other parts of the body is often fatal.
This is a bit of a serious matter. Because this disease is difficult to treat, and because most people who develop it have low immunity, the mortality rate is high. But don't give up hope, there is a chance of recovery with early treatment.
When should I see a doctor?
If you have any of the following conditions, ask a doctor how to prevent fungal infections and how to recognize them early:
- If you have diabetes or cancer.
- If you have had an organ transplant or stem cell transplant.
- If you have a medical condition or are taking medication that weakens your immune system.
When should I go to an Emergency Treatment Unit (ETU) ?
Mucormycosis can be fatal if not treated promptly. If you have symptoms of mucormycosis, especially if you have a weakened immune system or diabetes, go to an emergency room immediately. Always seek emergency care if you have any of the following severe symptoms:
- High fever (over 103 Fahrenheit/40 Celsius).
- Difficulty breathing.
- Coughing up blood.
- Bulging eyes or swelling around the eyes.
- Vision changes, such as double vision.
- Confusion or other mental changes.
- Convulsions.
- Black mucus or tears.
- A wound that does not heal, continues to spread, or turns black.
If you have any of these signs, go to the hospital without delay!
What questions should I ask my doctor?
It may be helpful to ask your doctor these questions:
- Am I at higher risk of developing fungal infections?
- What can I do to reduce my risk?
- What symptoms should I look out for and when should I seek medical advice?
- What treatment options do I have?
- What can I expect with this diagnosis?
Are there ways to prevent Mucormycosis? (Prevention)
The fungi that cause mucormycosis are all around us, so it's difficult to completely avoid them. But here are some steps you can take to reduce your risk of fungal infections:
- If you have a medical condition that puts you at risk for serious fungal infections, work with your doctor to manage it.
- If you are at high risk for fungal infections, your doctor may prescribe antifungals to help prevent you from getting sick.
- If your job puts you at risk of exposure to fungi, ask your doctor if you are at increased risk of infection.
- Avoid dusty areas, such as construction sites. If you absolutely have to be in such areas, wear an ``N95`` mask (or other protective equipment) that helps filter fungal spores from the air you breathe.
- Avoid activities that may expose you to fungal spores, such as gardening and digging. Wear gloves and clothing that covers as much skin as possible when working outdoors.
- Wash cuts and scrapes thoroughly with soap and water.
Does COVID-19 increase the risk of Mucormycosis?
In 2021, there was an increase in mucormycosis cases among people who had COVID-19. But experts aren't sure exactly what the link is. They're also not sure whether having COVID-19 itself is enough to increase the risk, because:
- Most cases were reported from regions of the world where mucormycosis is common. During the COVID-19 pandemic, about 1 in 3 people with mucormycosis in these regions did not have COVID-19.
- During the pandemic, several cases of both COVID-19 and mucormycosis were reported in other parts of the world (where mucormycosis is usually less common), but there were no outbreaks of the fungal infection in areas where mucormycosis is usually less common.
- Many people who had both mucormycosis and COVID-19 had poorly controlled diabetes or were taking corticosteroid medications. These are risk factors for mucormycosis.
- Many people who had both COVID-19 and mucormycosis had the type that affects the nose, eyes, and brain (rhino-orbital-cerebral mucormycosis) – not the typical lung infection that you might expect. This also suggests that other underlying conditions, not just COVID-19, contribute to this infection.
So, it's hard to say right away that this is caused by Covid-19. There could be other factors that contribute to it.
Finally, things to remember
Mucormycosis is a rare disease . It affects about one or two people in a million each year. But if you have any health conditions that weaken your immune system, you are at higher risk. People with diabetes and high A1C should be especially careful.
Managing your underlying health conditions is the best way to stay healthy. But talk to your doctor about other ways to reduce your risk of infection. He or she can discuss any concerns you may have and tell you what symptoms to look out for.
This is not a disease that affects everyone. However, if you have a disease that weakens your immune system, such as diabetes, be very careful. The most important thing is that if you have symptoms of mucormycosis, go to the emergency room of the nearest hospital immediately. Because quick treatment can save lives!
` mucormycosis, black fungus, fungal infection, diabetes, immunity, sinus, lung, skin, brain, fungus
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