BLACK FUNGUS,  A FATAL INFECTION OF THE ORAL AND PARAORAL STRUCTURES

What is Black fungus, or mucormycosis, and why is it on the news?

Mucormycosis is a fungal infection caused by a mold or fungus called mucormycetes. This is rare but if present, can become quite serious. 

Rhizopus, Mucor, Rhizomucor, Syncephalastrum,  Cunninghamella bertholletiae, Apophysomyces, and Lichtheimia species are the causative agents of mucormycosis.

Following covid 19 infection, many patients are reporting development of black lesions in the nose, paranasal sinuses, mouth and respiratory tract. Investigations and biopsies have revealed growth of mucormycetes fungi. 

This disease can be classified according to the site where the fungus predominates. We have five basic types.

1.Mucormycosis off the sinuses and brain.

2.Mucormycosis of the lung

3.Mucormycosis of the digestive tract and

4.Mucormycosis of the skin and

5.Disseminated Mucormycosis 

HOW DOES THE FUNGUS SPREAD AND INFECT?

The mucormycetes fungus is present almost everywhere, in the environment. Usually the healthy human body can easily fight off the fungus with the help of its immune systems. The fungal spores can be inhaled or cause infection through direct skin contact through wounds. However, the following conditions can precipitate an attack of the fungus.

  1. Uncontrolled diabetes
  2. Organ or Stem cell transplant 
  3. Cancer
  4. Premature or low birth weight children 
  5. Cuts on skin from surgeries, burns, trauma
  6. Weak immune system, especially after taking lots of antibiotics and/or steroids
  7. Most recently, recovered covid patients are reporting mucormycosis 

Hence, it becomes very important to know more about Mucormycosis. 

Usually the fungus is harmless, but when the patient has very weak immune system, especially after heavy dosages of steroids or antibiotics or antiviral drugs, the fungus can reach the sinuses or lungs or other parts, especially through air. This point is particularly important in wake of usage of heavy medication in covid patients with additional complicating factors like diabetes, transplants etc.

CLINICAL FEATURES:

A classic clinical sign of mucormycosis is the rapid onset of tissue necrosis with or without fever. Various signs and symptoms include:

Unilateral facial swelling, headache, nasal or sinus congestion with pain, nasal discharge, fever, visual disturbances, black coloured lesions on hard palate, drainage of black pus from eyes, cough, chest pain, difficulty in breathing, abscess formation, necrosis, cutaneous black lesions, abdominal pain, nausea, vomiting, and other symptoms are observed according to the site where it’s infected. Gastrointestinal mucormycosis is common in infants. Diabetic and neutropenic patients usually suffer from rhinocerebral mucormycosis. Pulmonary mucormycosis occurs usually in neutropenic and cancer patients. 

Transmission

Transmission occurs through inhalation, inoculation, or ingestion of spores from the environment. Although most cases are sporadic, healthcare-associated outbreaks have been linked to adhesive bandages, wooden tongue depressors, hospital linens, negative pressure rooms, water leaks, poor air filtration, non-sterile medical devices, and building construction. 

 This explains why mucormycosis has been on the rise since the covid pandemic broke out. 

Diagnosis

A definitive diagnosis of mucormycosis typically requires histopathological evidence or positive culture from a specimen from the site of infection. 

Prognosis

Usually the mortality rate is 50%, on an average, but the exact prognosis depends on the complexity of the infection.

Persons with uncontrolled diabetes; malignancy; hematopoietic stem cell transplant or solid organ transplant; persistent neutropenia; prolonged corticosteroid therapy; skin trauma, burns, or surgical wounds; iron overload; intravenous drug use; malnourishment; and premature infants form the major risk group. However, covid 19 treated patients with the above existing co morbidities can also be added In the above risk zone.

Is mucormycosis contagious?

No. Mucormycosis can’t spread between people or between people and animals.

Treatment 

Antifungal drugs like Amphotericin B, and other antifungal agents have been found effective.

In complicated cases, surgeries and hyperbaric oxygen therapies are required. 

Is mucormycosis fatal?

If not diagnosed, or if left untreated for a long time, mucormycosis can turn fatal. 

Visit your dentist or physician if you find black spots in your palate or in the nasal areas, especially if you have been treated for covid 19. 

At The Dental Specialists, our doctors are committed to diagnose, treat and prevent oral infections. Make sure you have the right information, and the right specialist to advise you about the post covid care.

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