India is still combating the second wave of the infamous COVID-19 when an unforeseen nightmare sets into reality. When globally people were suffering and striving against the pandemic, India had to withstand one more internal battle Fungus in Covid-19 patients: An Epidemic in a Pandemic. Unlike Coronavirus, this time the unpleasant guest isn’t any new to us. They are present anywhere and everywhere say who? Fungus.
Fungi are a very diverse member of eukaryotic organisms which are recognized and classified as a separate kingdom. They are an irreplaceable part of the ecosystem and microbial clique. These organisms are commonly present as moulds, yeast, rusts, mildews and mushrooms around us. This gives a moment to ponder over the reason behind the sudden outburst and attack of these rare variants in the recovered and affected COVID 19 individuals.
Are All Fungus Lethal?
- About 120,000 species of fungi have been identified till now. Millions of unidentified species are yet to be recognized which can be evolutionary troves.
- Fungi are distinctive in their adaptability and flexibility thereby serving as an origin of genetic diversity.
- Due to its ubiquitous nature, fungal infections and disease often originate from common fungi found in the environment.
- Infections caused by fungi are either primary or opportunistic infections which mean that either the fungi take advantage of an abnormal balance or takes dominance of weakened immunity.
- Though there are many lethal and dangerous fungi present, not every species is harmful to mankind.
- The first accidentally discovered antibody penicillin, Baker’s yeast and mushroom find significant application in food and medicine.
India’s Epidemic In Pandemic– Fungus in Covid-19 patients:
- During the first wave of COVID-19 various countries reported the COVID-19 associated invasive fungal infections.
- Fungal infections have been previously reported during the SARS epidemic in 2003 which had a mortality rate ranging from 25% to 73%.
- The black fungus was the first COVID-19 associated invasive fungal infection reported during the ravaging second wave of COVID-19 followed by the reports of white fungus and yellow fungus.
- This article will brief on the reasons why there is a terror of fungus in COVID-19 individuals.
Know The Black Fungus:
- Mucormycosis has been there time immemorial and the disease isn’t any new to the world and the species is found abundant in India.
- The name black fungus is a misnomer as Mucor is not a part of the black fungus family.
- Black fungus is commonly called pigmented fungi or Dematecious fungi and is the polar opposite of the mucor fungus family.
- Mucormycosis is called black fungus because it causes necrosis of tissue which results in the production of black eschar (black dead tissue). As the tissue turns black due to necrosis it was called black but scientifically it isn’t.
- Dr.K.C. Rondello, epidemiologist confirms that Mucormycosis is a very rare and invasive fungus that is caused by a group of mucoromycetes found in soil, organic matter. (Centres for Disease Control and Prevention)
- Mucormycosis attacks weakened immune system which provides an opportunity for fungus attack.
- This species needs fertile soil, low oxygen or total lack of oxygen, acidosis, high blood glucose and suppressed immunity to grow. Unfortunately, the patients recovering or affected from COVID-19 possess the highest probability of getting infected as they have combinations of factors listed above.
- Though the Mucormycosis infection is lethal and has a high mortality rate, it is not contagious assured Cioe-Peña.
- The pre-covid era also had reports of this species infection in patients diagnosed with diabetes and people who overuse steroids, immunosuppressants.
- Clinically there are no clear establishments that peg that the virus is accountable for the spread of infection and surge in cases but many clinical scientists claim that the COVID 19 could lead to secondary infections.
- The individual affected and recovering from COVID-19 are having a higher chance of getting infected as they intake immunosuppressant drugs like dexamethasone, undergo oxygen therapy in ICU where humidifier provides an opportunity for the fungus to invade.
- The fungus which is ubiquitous if infects through a cut or burn causes localized infection but if it enters through the sinus, it can immediately affect the eyes, lungs and eventually the brain leading to fatal death. Patients diagnosed with HIV/AIDS, Cancer, Diabetics are usually prone to these infections.
Symptoms Of Black Fungus:
- Facial swelling
- Nasal Congestion
- A Headache
- Shortness of breath
- Eyelid loss
- Blurred vision
- Loss of eyesight
- Formation of black scabs and crusts
- Facial numbness
- Dental complications
Diagnosis and Treatment of Black Fungus:
- The infection of Mucormycosis is diagnosed by a blood test, MRI scan, CAT scan. A biopsy is conducted to confirm apart from clinical examinations.
- Primarily anti-fungal drugs are prescribed to the diagnosed individual. Self-medication is a big no for this infection.
- In extreme cases, doctors remove the deceased tissue due avoid major complications and prevent the further spread of the fungus in the body. This surgical procedure may sometimes result in disfiguring.
- The most sought out anti-fungal drugs to treat this rare infection is Amphotericin B while isavuconazole and Posaconazole also help in better treatment as second-line drugs.
- Amphotericin B is a fungicide that leads to fungal cell death. When it binds with ergosterol which is a prime component of the fungal cell membrane it leads to leakage of monovalent ions and ultimately death of the cell.
- The second line drug, Posaconazole acts by inhibiting the production of ergosterol by inhibiting and binding to lanosterol-14alpha demethylase which is found in all almost all fungi.
Know The White Fungus
- Aspergillosis is caused by Aspergillus, a common fungus present as mould around us and is unavoidable. Many people inhale Aspergillus spores but due to our enigmatic immune defence, they don’t get infected.
- The patients affected by the COVID-19 due to compromised immunity and lung infection constitute an elevated risk of developing Aspergillosis.
- The name white fungus is because it attacks various parts and results in white discharge and not because it belongs to a particular family.
- The white patches are due to Candida which causes Candidiasis, a general fungal infection.
- Unsanitary oxygen use, steroids overuse, humidifier heightens the possibility of getting infected by this species
- Unlike Mucormycosis, these strains affect several body parts including skin, kidney, brain, mouth, digestive tract, genitals and lungs
Symptoms of White Fungus:
- White patches on the skin
- White tongue
- Difficulty in eating and swallowing.
Diagnosis and Treatment of White Fungus:
- To diagnose the infection of Aspergillus and Candida, CT lung scan, tissue biopsy, blood test and fluid sample from the respiratory tract is collected and examined.
- The anti-fungal drug is prescribed to the infected individuals. Oral application of fluconazole is given for candidiasis.
- Severe cases of infected individuals are treated with Micafungin in invasive Aspergillosis.
Know The Yellow Fungus:
- Mucor septicus is a fungal infection prevalent in reptiles like lizards. These infections are affiliated with severe COVID-19 individuals.
- This fungus attacks the body’s internal organs and disturbs the harmony of vital processes. It causes pus leakage, delays healing of wounds and in extreme cases results in organ failure and death.
- Cases of infections have been reported worldwide. For instance, N. hominis, a human-specific yellow fungus was recovered from an HIV positive individual’s groin lesions and inguinal node.
- Poor hygiene, high humidity, unsanitary conditions serve as primary factors for the growth and spread of this fungus species.
Symptoms Of Yellow Fungus:
- Weight loss
- Loss of appetite
- Sunken eyes
- Prolonged healing
- Necrosis of tissues
- Pus leakage
- Slow metabolism
Diagnosis and Treatment Of Yellow Fungus:
- The infection is diagnosed similarly to other fungus using a blood test, biopsy and CT scan
- Currently, this rare infection is treated with Amphotericin-B which also finds application in treating Mucormycosis
The Bottom Line:
Steroids remain lifesaving drugs in many diseases but, overuse of these drugs makes the impaired individual vulnerable to the microorganisms surrounding them. It is necessary to recognise the fungi based on their family and characteristics instead of colours. We, humans, coexist in this ecosystem with several microbial species hence it is quintessential to maintain proper hygiene and sanitised environment to have a disease-free lifestyle. When we know something in its course of time might become dangerous then it better to take a precautionary step to combat the impending danger as Prevention is always better than cure!
CDC Works 24/7. (2021). Retrieved 6 June 2021, from https://www.cdc.gov/