Mucoreal

About Disease

Fungus/ Molds are often found in the form of spores in the air & can be present everywhere around us. Inhalation of these spores is mainly responsible for invasive infections. Occasionally, entry of the mold Mucor/ Mucorales through minute cracks in the skin can cause the infection. However, the following patients are at higher risk of developing IFI.

1. COVID - 19 patients who were on a high dose or a prolonged course of steroids.

2. Prolonged stay in a hospital & especially in ICU.

3. Uncontrolled Diabetes Mellitus.

4. Prolonged use of Steroids for any ailment.

5. Leukemia, lymphomas.

6. Solid-organ transplants.

7. Bone marrow transplants.

8. Voriconazole therapy.                                                                                                                   

Signs & Symptoms of Disease

1. Sinusitis – nasal blockage or congestion, Nasal discharge (blackish/bloody).
2. Local pain on the cheekbone.
3. One-sided facial pain, numbness, or swelling.
4. Pain and redness around eyes and/or nose.
5. Blackish discoloration over the bridge of nose/palate Toothache.
6. Loosening of teeth with jaw involvement.
7. Blurred or double vision with pain, Fever, Headache, Coughing, etc. is some early signs of Mucormycosis Infection.
8. Shortness of breath, Skin lesion-thrombosis & necrosis (eschar), Chest pain, pleural effusion, haemoptysis, bloody vomit, worsening of respiratory symptoms are signs when the infection is spreading to other parts of the body.
9. The altered mental status also occurs when the infection starts affecting the nervous system of the patient.
10. In early symptoms of nasal discharge, one-sided facial pain & nasal blockade, if the disease is diagnosed & treated by consulting an ENT specialist the patient can be cured with less damage.
11. In case of pulmonary infection due to mucor, the diagnosis could be detected late. Thus a real-time PCR test would be recommended to detect circulating DNA in serum also from fungi Mucor at the early stage itself.

Why Mucormycosis is most affected in Covid 19 patients?

In Covid 19 treatment since the main focus is on Oxygen saturation, Glycemic control might be ignored to some extent. Also, excessive usage of steroids & their dosage which act as immunosuppressants can trigger the growth of Mucor infections in patients.

High Ferritin levels could be another reason for the growth of Mucor mold. Ferritin has iron components that enable the growth of Fungi Mucor.

The Mucormycosis infection usually occurs after 15 to 18 days of Covid infection, possibly when the patient is discharged from the hospital, thus while discharging the Covid 19 patients, especially those diabetics are advised to do this test.

How can one prevent the Mucormycosis Infection?

Prevention may not entirely be possible but the following can help in reducing the incidence -

1. Controlled Hyperglycemia, Monitoring blood glucose level post-COVID-19 discharge irrespective of History of diabetes in the patient.
2. Using steroid judiciously i.e. correct timing, correct dose, and duration.
3. Use of clean, sterile water for humidifiers during oxygen therapy.
4. Use antibiotics/antifungals judiciously.
5. Use masks if you are visiting dusty areas like construction sites etc.
6. Wearing shoes, long trousers, long sleeve shirts, and gloves while handling soil (gardening), moss, or manure.
7. Maintain personal hygiene including a thorough scrub bath.
8. Observing any early signs and symptoms & consulting the doctor especially after Covid 19 infection or comorbidity.
9. Do not consider all the cases with a blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients.
10. Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDI-TOF), for detecting fungal etiology.

How is mucormycosis diagnosed?

There are different tests to diagnose the condition.

1. Direct examination of the sample using special stains in Microbiology – KOH or CFW
2. Fungal culture of the sample using special culture media in Microbiology.
3. Species-level identification using MALDI TOF or conventional morphology study.
4. Histopathological examination of the tissue using special stains like GMS.
5. Immunodiagnosis – BD glucan can be used in invasive fungal infections and Galactomannan can be used to rule out Mucormycosis.
6. Molecular diagnosis- to detect DNA of pathogens causing Mucormycosis. Highly sensitive and specific test. 

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