As the country battles the deadly second wave of coronavirus, several thousand cases of fungal co-infections have been reported in COVID-19 patients: Throughout the country, infections of black fungus or mucormycosis, white fungus, yellow fungus, and green fungus are imposing a serious threat. The severity of the infection can be gauged from the ICMR study conducted in the last week of May 2021, according to which more than half of the COVID-19 patients who get a fungal infection die.
Black Fungus (Mucormycosis)
The black fungus (mucormycosis) has been declared as an epidemic in India under the Epidemic Disease Act. All types of fungal infections are caused by mucormycetes, which is always present in the environment. Mucormycetes are present in soil, decaying organic matter like leaves, compost piles, and animal dung. In their day-to-day life people usually come in contact with fungus but do not get infected due to the natural immunity present in their body.
The fungal infections have been prevalent before but there were much fewer cases and in people with low immunity. The numbers have spiked due to COVID-19 related lower immunity and certain additional risk factors.
The second wave of COVID-19 pandemic resulted in a large number of people getting severely ill, which led them to have prolonged ICU stay, high blood sugars, and prolonged oxygen use. Previously, mycoses or fungal infections were mainly found to inflict people with chronic kidney disease, uncontrolled diabetes, HIV-AIDS, those undergoing chemotherapy and on anticancer drugs, but the COVID patients with these added conditions triggered a steep rise in the number of people who were severely immunocompromised, at a much higher level than before, and these people were at a very high risk of getting these fungal infections.
This fungal infection, caused by the Mucorales order, in which the species most commonly implicated are Rhizopus, Mucor, and Absidia. Mucormycosis or black fungus is caused by mucor. The infectious agent enters into the blood vessels and tissues causing interruptions in blood supply to normal tissue, leading to necroses changing to colour (black). Due to this reason it is known as black fungus infection.
Black fungus can impact a patient’s face, nose, eye orbit, and even brain, leading to vision loss. The fungus can also spread to the lungs. As per Randeep Guleria, the director of All India Institute of Medical Sciences (AIIMS), black fungus mostly occurs due to the misuse of steroids.
Causes of Infection Mycoses are all opportunistic infections, which means they attack an individual who has a weakened immune system. Our immune system is supposed to fight off any invasion by fungi and bacteria but the lack of immunity allows the fungus to spread, invade, and destroy tissue. Generally, people having diabetes, COVID-19 patients, and those who have been consuming steroids for many days are at a higher risk of getting infected with black fungus. Even staying in ICU for a long period can increase the risk of black fungus.
Symptoms Recently, it has been found that those who are recovering from COVID-19 are mostly contracting black fungus. Some common symptoms of its early detection include discolouration over the nose, blurred vision, pain on one side of the face, toothache, pain in the chest, and breathlessness, altered sensation on the cheek, due to invasion of the nerve supplying that area, the nasal cavity leading to nose block, nasal discharge which is blood-stained and smelly, spread to the sinuses and brain, swelling in the eye, sudden loss of vision, bulging of the eyeball. It may also spread to the palate and present as loose teeth and swelling on the gums. It may be found in far-off places like kidneys and ureters spreading via the bloodstream. It has also been found that infected patients have also coughed out blood. It can turn fatal if not treated immediately.
Precautions are debatable with respect to the efficacy in preventing these infections. One can use saline nasal irrigation, or use dilute betadine drops in the nose. These are not proven to be effective but are recommended by certain physician associations. With regards to candidiasis (infection caused by yeast), one needs to maintain oral hygiene to prevent oral thrush.
But the effective prevention requires ensuring a good immune system, especially in post-COVID patients. Strict monitoring of diabetes and avoiding dead/decaying organic matter will help. In case of post COVID-19 infection, one should be vigilant for the symptoms. Surveillance with regular nasal endoscopy post-discharge from hospital, for at-risk patients should be advised. A sampling of the nasal mucosa with swabs and sending them for a basic Potassium hydroxide (KOH) mount test should be done in suspicious situations. Self-medication and taking antibiotics as per baseless advices through social media should be avoided.
If one develops mucormycosis symptoms he/she should seek proper medical advice at the earliest without being panic.
White Fungus
White fungus is a genus of yeast called Candida, which grows in the lab as white or creamy white spots on plates of agar. Candida albicans is the most commonly isolated species. Albicans means white. Hence, the term white fungus. Most commonly, they appear as white or creamy spots on the mucosa of the oral cavity in humans. They are commensals in the oral cavity and gastrointestinal tract and are present on skin as well. Candida infection can lead to simple oral thrush, i.e., whitish spots on the mucosal lining of the mouth and throat, which may, thereafter, spread to the throat and oesophagus. It may get disseminated and spread to the eye as have been reported recently in Mau, Uttar Pradesh. The infection may be found in the heart and genitalia as well.
White fungus is found to be more dangerous than black fungus. Doctors have also warned that if the fungus is not timely attended, it can lead to death. It badlyaffects the lungs and can cause damage to the brain, respiratory system, and digestive tract.
Causes of Infection White fungus mostly attacks people who have low immunity. Unsanitary places with moulds make a perfect environment for anyone to catch this infection. Though not contagious, people around the infected person can catch it by inhaling it, if they have low immunity. Diabetics and cancer patients and those consuming steroids for long are at higher risk.
Symptoms Some early symptoms of white fungus are quite similar like COVID-19 symptoms. A patient can have pain in the chest, cough, breathlessness, headache, body pain, infection in some body parts or swelling.
Yellow Fungus
Yellow fungus is a term coined anonymously is of little significance. Yellow is the colour of pus, which is formed whenever there is any bacterial infection. Further, there may be fungal growth of a wide variety of species. It does not mean that the fungal infection is causing the colour.
On the other hand, experts also view that this fungus is the most lethal of the three types of fungus discovered till now. It usually affects reptiles and the first human infection was reported in Ghaziabad in May 2021.
Causes of Infection While not much is known about the infection, it is important to know that this kind of infection starts due to unsanitary conditions. Yellow fungus may be caused due to poor hygienic surroundings, contaminated food, overuse of steroids, antibacterial medications, and poor oxygen use. It has been advised to keep the surroundings clean and humidity freeand remove old foods and faecal matter as soon as possible so that bacteria and fungus do not grow and develop.
Symptoms Yellow fungus starts off internally. Some early symptoms include pus leakage, slow healing of wounds, lethargy, lack of appetite, loss of weight, and sunken eyes. In severe cases, it can also show devastating symptoms like organ failure.
Green Fungus
Green fungus is caused by aspergillus, a common type of fungus that is found indoor as well as outdoor. The medical name for this disease is aspergillosis. According to Centres for Disease Control and Prevention (CDC), while some allergic green fungus attacks may not cause infection, in other cases, it can affect the lungs. Invasive aspergillosis typically affects the lungsbut can also spread to other parts of the body. Then, there is cutaneous or skin aspergillosis, in which case the green fungus enters the body through a rupture in the skin. There are also instances of it occurring after invasive aspergillosis spreads to the skin from somewhere else in the body like the lungs.
Causes of Infection Though everyday exposure to aspergillus is not always a problem, it may cause serious infection. The various types of infection that green fungus can cause are commonly seen affecting people who have cystic fibrosis or asthma or lung diseases like tuberculosis. Chronic pulmonary aspergillosis can affect people who have other lung diseases, like tuberculosis (TB), chronic obstructive pulmonary disease (COPD), etc. People with weakened immune systems like those who have had an organ transplant or are undergoing chemotherapy for canceror taking high doses of corticosteroids (like some COVID-19 patients do) are at risk of developing invasive aspergillosis. However, aspergillosis does not spread between people or between people and animals from the lungs.
Symptoms The different types of infections that green fungus may trigger can have different symptoms. For instance, when the green fungus triggers an allergic reaction in the lungs, allergic bronchopulmonary aspergillosis (ABPA), it produces symptoms similar for asthma like wheezing, shortness of breath, coughing, and fever in rare cases. When the allergy attacks the sinuses, it can cause stuffiness, runny nose, headache, and in a symptom common with COVID-19, reduced ability to smell. Similarly, chronic pulmonary aspergillosis that affects the lungs can lead to weight loss, coughing, coughing up of blood, fatigue, and shortness of breath.
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