Black fungus: the keys to understanding how and who affects mucormycosis

Mucormycosis is a opportunistic fungus which mainly affects people with diabetes and immunosuppression, patients with malignant diseases such as leukemia and those suffering from malnutrition. It is also common in those who have received a transplant, those with drug addiction and in people with positive HIV status.

Mucor can affect the lungs, central nervous system, gastrointestinal tract, and skin; however, the most common presentation is the rhinocerebral, which initially affects the nose and sinuses.

Currently, the cases are known mucormycosis infections after recovery from SARS-CoV-2 infection; that is, it would form the prolonged COVID syndrome or COVID long.

One of the groups most susceptible to this fungal infection is, as mentioned, people with diabetes whose treatment is not under control and who suffer from ketoacidosis. Other people at higher risk of developing this condition are those who received steroids (corticosteroids) during treatment for COVID-19 and those who have had a long period of hospitalization in intensive care..

When it comes to steroids, it is important to state them for the time needed to reduce inflammation.. These drugs are given to patients with COVID to reduce lung inflammation and prevent damage to the immune system. The latter is “accelerated” to stop the coronavirus; on the one hand, it fights it but, on the other hand, it increases blood sugar (blood sugar). For this reason, in people with diabetes and in whom it is difficult to control blood sugar, the chances of this fungus appearing are increased.

In otolaryngology, it is quite common to find infections such as mucormycosis. The first description of this disease in the upper respiratory tract was made in 1885 by Arnold Paltauf, a Slovenian physician who called this disease mycosis mucorina and later received its present name.

This nasosinus mucomycosis can have an invasive form (and, within it, the acute fulminant, invasive granulomatous and chronic invasive forms) and a non-invasive form, including mycetoma and fungal allergy.

The signs and symptoms of this disease are, in descending order:

-Fever

-Nasal ulceration and necrosis

-Oedema of the face and face

-Decreased vision and ophthalmoplegia

-Sinusitis, headaches and facial pain

-Obnubilación

– Orbital cellulitis

-Necrosis of the palate and gums

-Paralysis of the facial nerve

-Rinorrhea, nasal congestion and nosebleeds (epistaxis)

The progression of the disease will depend on the patient’s condition, the degree of immunosuppression and predisposing factors. As mentioned, sudden, sharp or chronic images can be seen.

The acute fulminant form is of rapid progression with vascular dissemination of the fungus, which compromises the eye socket and can cause facial paralysis and blindness.

The chronic invasive form is of the indolent type and is presented in association with diabetes mellitus and steroid therapy.

In general, treatment of mucormycosis consists of high doses of amphotericin B and surgical cleansing if necessary in the presence of necrotic tissue.

Today, there are azole antifungal agents and other agents modifying the biological response and measures to reverse the immune compromise.

Cases of mucormycosis after coronavirus infection have increased fivefold from usual cases of this disease, which is not very common under normal conditions.

The first cases appeared in Uruguay, and at present the severity and frequency of cases in India are surprising.

For all that has been mentioned before, It is important to constantly monitor blood sugar levels, ensure the sterility of the humidifiers used in case of oxygen demand and start treatment if there is clinical suspicion., without waiting for confirmation of infection by culture, which usually takes several days.

* Stella Maris Cuevas (MN: 81701) is an ENT – Odor expert – Allergist. Former President of the Association of Otolaryngology of the City of Buenos Aires (AOCBA)

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