How to deal with Mucormycosis aka Black Fungus: By Dr Vinay V Rao




 

 

 

 

 

 

 

 

 

 

 

 


By Dr Vinay V Rao

May 18: In the face of this pandemic when the whole world is grappling with different challenges we have our own unique problem, Rhinocerebral Mucormycosis aka ‘Black Fungus’. It is not something new, but it was never this common. In simple words it is an opportunistic fungal infection of nose and sinuses affecting predominantly immunocompromised and highly diabetic patients. In the past the occurrence was as less as 1 to 2 cases in a year in any tertiary care centre. In my early years as a consultant I had operated on 3 cases over a period of 2 years and published it in a peer reviewed journal and to my surprise a physician from Srinagar had called me to ask about my experience as they had not seen any cases, it was that uncommon.

So what happened in these past few months that suddenly it is all over the news? COVID caught all of us unprepared without any guidelines about management, almost everyday newer guidelines were sent and we are constantly adapting. Out of all the information in hand few highlights emerged, we need to give oxygen and improve lung functions. In light of which steroids and immune modulators were used to suppress the hyper immune response in order to save life. It worked and survival improved. However, with every good comes the evil. What also happened was that sugars shot up, pre existing diabetics became worse and new diabetics emerged. This combination of indiscriminate steroid use, self medication and poor glycemic control gave a perfect environment for the BLACK FUNGUS to grow. Like a silent player it got comfortable in our nose and saw an opportunity to shine and grabbed it with both its hands and started making noise. Do not worry we have your back.

How do I know if I’ve black fungus infection?

Common symptoms: Facial pain, focal headaches especially over forehead, temple and vertex. Toothache (upper jaw), eye pain, nose block, blood stained discharge. More alarming features like: visual disturbance, double vision, fever, splitting headache, seizures, stroke or paralysis.

If you have any of these seek immediate medical help.

What will a clinician do?

If BLACK FUNFUS infection is suspected then you would be referred to an ENT surgeon who will do a detailed clinical examination and ask for either a CT or an MRI scan. He can also do an endoscopy to confirm the diagnosis and send a swab for fungal studies. In any situation you will have to follow up with the reports.

What am I to do if I am diagnosed with BLACK FUNGUS?

First do not worry, stay positive and motivated. In most of the cases you would be explained about the need for surgery (with few exceptions), usually endoscopic. Surgery is a bit aggressive to contain a relatively lethal disease which may involve removal of facial bone and adjacent non bony structures. This will be followed by anti fungal injections for at least a week. You will be monitored closely with serial examinations and blood tests. Sometimes the treatment is protracted and might warrant repeated debridements and longer hospital stay, a lot depends on patient response to treatment.

TIME is of the essence here. Seek medical help at the earliest, delay can cost you your life.

There is a sudden surge of BLACK FUNGUS infection across the country further strangulating the already strained medical healthcare system but, we are here to help. We can fight if we act now.

 


Dr Vinay V Rao is an Associate Professor in ENT & Head Neck Surgery at Fr Muller Medical College, Mangaluru. He is a Consultant ENT specialist at Valencia health center, Valencia. Contact at 8050076660, drvinayvrao@gmail.com.

 

 

  

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Comment on this article

  • Evans C Sumitra, Udupi/New York, USA.

    Tue, May 18 2021

    My big salute to Dr. Vinay V Rao for the useful information on Mucormycosis aka Black Fungus. This will help many people who are not aware of this new disease. If some are or are going through similar symptoms should go to an ENT surgeon before it is too late.

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  • Rudolf Rodrigues, Mumbai

    Tue, May 18 2021

    If news reports are to be believed, deadly Mucoromycosis is spreading like wild fire throughout the country! Already there is a shortage of drugs to treat this; the administration needs to work on a war footing to acquire sufficient amount of medication to avoid mutilated faces & deaths! Also, it's time for ENT surgeons to get ready for sleepless nights as patients pour in!

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  • Rudolf Rodrigues, Mumbai

    Tue, May 18 2021

    Bhavya, read the story Ignaz Semmelweis an Hungarian surgeon who saved many deaths caused by peurpural fever caused after childbirth by suggesting hand washing before conducting deliveries; he was radiculed by his bosses and ultimately insulted & forced into a mental asylum and beaten to death; today see what a great discovery his was! Same with blood letting to cure various diseases which went on for years! There are innumerable examples like this! So remove your horse blinders & read & research before naming someone a quack; what sort of quackery was in my post! I hope better sense prevails in future!

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  • Rudolf Rodrigues, Mumbai

    Tue, May 18 2021

    Monty, just now I found a report on DECCAN HERALD, today's edition, pg 4, that total cost of medicine, liposomal type, will be approximately 4.2L! Please do your own research & decide!

    DisAgree Agree [4] Reply Report Abuse

  • Monty Dotor, Mangalore

    Tue, May 18 2021

    This information I got from a doctor friend in Mumbai about 15 days back, now it is short supply.Also different manufacturers will have different prices, if it is billed by the hospital the charges are much higher.

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  • Monty Dotor, Mangalore

    Tue, May 18 2021

    @Bhavya . Learn to respect all forms of medicine- Allopathy, Ayurveda, Homeopathy, Unani , Naturopathy etc etc. Remember Edward Jenner who "discovered " the vaccine for smallpox , got the idea from his milkmaid who challenged him that she wiil never get smallpox because their cows had cowpox- the concept of cross immunity was thus born. I am an allopath but the quinine that is used for cerebral malaria, was used in Homeopathy by the father of homeopathy many years back and the "Sudarshan Churna" of Ayurveda also has the same Quinine as the prime chemical ingredient. Pick and adopt the good points of others, to achieve success in life.

    DisAgree [2] Agree [3] Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Tue, May 18 2021

    Bhavya, read the story Ignaz Semmelweis an Hungarian surgeon who saved many deaths caused by peurpural fever caused after childbirth by suggesting hand washing before conducting deliveries; he was radiculed by his bosses and ultimately insulted & forced into a mental asylum and beaten to death; today see what a great discovery his was! Same with blood letting to cure various diseases which went on for years! There are innumerable examples like this! So remove your horse blinders & read & research before naming someone a quack; what sort of quackery was in my post! I hope better sense prevails in future!

    DisAgree Agree [3] Report Abuse

  • Monty Dotor, Mangalore

    Tue, May 18 2021

    @Rudolf The info I got from a doctor friend in Mumbai, but prices will vary from manufacturer to manufacturer ,and BTW now it is in short supply.

    DisAgree Agree [3] Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Tue, May 18 2021

    Doc, please can you give the cost of medication if one were to use liposomal Amphoterecin as against Amphoterecin B, which is supposed to be highly nephrotoxic?

    DisAgree Agree [4] Reply Report Abuse

  • Bhavya Baliga, Udupi

    Tue, May 18 2021

    I don't think it is possible for him to answer in these columns, so please ask your quack.

    DisAgree [10] Agree [2] Report Abuse

  • Monty Dotor, Mangalore

    Tue, May 18 2021

    50 mg costs Rs 2600 presuming 1gm has to be used in 20-30 days the cost will be Rs 52000, ( other charges extra) it is less toxic than Amphotericin B but still it is nephrotoxic. Dr Rao will correct me if I am wrong.

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  • Rudolf Rodrigues, Mumbai

    Tue, May 18 2021

    Bhavya, please; I didn't ask you the details!

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  • Dr Vinay V Rao, Mangalore

    Tue, May 18 2021

    Local control in the form of surgical debridement followed by Amphotericin B is the treatment guideline. Liposomal is preferred as it is not nephrotoxic like the cheaper and more readily available....Amphotericin deoxycolate. Price depends on the brand, with acute shortage and high demand it is getting difficult to source. Earlier we could get at discounted price from the distributor but now even that's not working out.

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  • M A RAHIM, Mangalore/moodbidri

    Tue, May 18 2021

    A layman can have good knowledge about mucormycosis ( black fungus) from this article. Thanks doctor for enlightening us.

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  • Rudolf Rodrigues, Mumbai

    Tue, May 18 2021

    One should understand that all fungi thrive prolifically in ill ventilated, devoid of sunlight, & damp places, also through air conditioning ducts & bird droppings; pigeons are the big culprits in spreading a multitude of fungi though mucormycosis is not spread by pigeon droppings!

    DisAgree [1] Agree [5] Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Tue, May 18 2021

    The sudden appearance of Mucormycosis cases in such large nos in Covid-19 patients indicates its primarily an hospital acquired infection by use of dirty humidifierwater, unsterlized instruments, equipment in a closed environment & the medical machinery overwhelmed to verge of collapse; but infections becoming fuminant in those with high diabetes & indiscriminate use of steroids during course of the disease! It needs to be nipped in the bud as it is highly fatal and a fast growing infection, before it spreads uncontrollably!

    DisAgree [2] Agree [22] Reply Report Abuse

  • Monty Dotor, Mangalore

    Tue, May 18 2021

    Yes.It is usually fatal and is spread now mostly by unsterile oxygen masks and ventilators, that is why the sudden increase in cases.It enters through the nose and spreads to paranasal sinuses,eyes and brain.The antifungal medicines are also toxic. The fungal spores are present in nature at many places esp. in bird droppings but only immunocompromised and uncontrolled diabetics get it, so it is important to keep diabetes under control rather than concentrate on the virus . It affects the elite more than the poor, so lifestyle diseases should get primacy in treatment to prevent mortality and morbidity of both covid and mucormycosis.

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  • Jossey Saldanha, Mumbai

    Tue, May 18 2021

    Dr. Vinay V Rao you have given us some Hope ...

    DisAgree [5] Agree [29] Reply Report Abuse


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