1/ 🧵on Mucormycosis (Black fungus)
COVID associated Mucor is increasingly being reported in India.
Spores of fungi are common in the environment. Infection occurs when circumstances are right.
Immunosuppression and uncontrolled diabetes are main culprits
COVID associated Mucor is increasingly being reported in India.
Spores of fungi are common in the environment. Infection occurs when circumstances are right.
Immunosuppression and uncontrolled diabetes are main culprits
2/ Spores of mucor are breathed in and cause infection
Risk factors
- Prolonged/high dose steroids suppress the immune system and elevate blood sugars, which further increase risk
- uncontrolled diabetes
- Widespread antibiotics may contribute via overgrowth of fungi
Risk factors
- Prolonged/high dose steroids suppress the immune system and elevate blood sugars, which further increase risk
- uncontrolled diabetes
- Widespread antibiotics may contribute via overgrowth of fungi
3/ Two main forms of post Covid mucor: rhinocerebral and pulmonary.
In one case series:
- 95% of pts had diabetes, mean HbA1C was 10.5
- Onset at median of 22 days after onset of Covid symptoms
- Only 5% occurred after mild Covid
In one case series:
- 95% of pts had diabetes, mean HbA1C was 10.5
- Onset at median of 22 days after onset of Covid symptoms
- Only 5% occurred after mild Covid
4/ Rhino cerebral Mucor:
Involves sinuses, eyes. Presents as nasal congestion and discharge, facial pain or swelling, toothache, blurred or double vision, redness of eyes, fever.
Extension into orbit can cause blindness
Necrotic tissue appears black - hence “black fungus”
Involves sinuses, eyes. Presents as nasal congestion and discharge, facial pain or swelling, toothache, blurred or double vision, redness of eyes, fever.
Extension into orbit can cause blindness
Necrotic tissue appears black - hence “black fungus”
5/ Pulmonary mucor: involves the lungs.
Presents with fever, hemoptysis, patchy infiltrates/consolidation/cavitation. ncbi.nlm.nih.gov/pmc/articles/P…
Presents with fever, hemoptysis, patchy infiltrates/consolidation/cavitation. ncbi.nlm.nih.gov/pmc/articles/P…
6/ Treatment:
- Antifungals active against mucor
- IV amphotericin or isavuconazole or
posaconazole.
- Surgical debridement essential in rhino-cerebral mucor
Outcome: 20% in hospital mortality despite treatment
- Antifungals active against mucor
- IV amphotericin or isavuconazole or
posaconazole.
- Surgical debridement essential in rhino-cerebral mucor
Outcome: 20% in hospital mortality despite treatment
7/ Prevention:
⁃Wearing a mask may prevent inhalation of spores
⁃Control blood sugars
⁃Do not use steroids for longer than necessary
⁃Avoid unnecessary antibiotics and voriconazole prophylaxis
⁃Wearing a mask may prevent inhalation of spores
⁃Control blood sugars
⁃Do not use steroids for longer than necessary
⁃Avoid unnecessary antibiotics and voriconazole prophylaxis
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