Emerging Syndemic: Black Fungus—A Post-COVID-19 Mucormycosis

Abstract

Novel coronavirus has created a havoc in India; about 30 million cases have been reported and 0.4 million deaths are recorded till now due to coronavirus disease 2019 (COVID-19). But nowadays, some patients of COVID-19 in India are battling a very rare but fatal disease, that is, mucormycosis or “black fungus” disease. The consciousness about the black fungus disease in many people of India is due to its rising cases of COVID-19-associated mucormycosis (CAM) mostly among the people who have recovered from COVID-19. Following recovery from COVID-19, thousands of cases of several complications of patients regarding CAM are reported especially during the second wave of COVID-19 in India. Mucormycosis or “black fungus” is a rare disease caused by fungi belonging to the order Mucorales. It is a disease observed following infection with the novel coronavirus in India and has already taken the form of a pandemic in many states.[1] [2] Therefore, scientists have chosen to name the disease as a syndemic since this is synergistically created with the pandemic. The ubiquitous molds of mucormycosis having a worldwide dispersal, including the Rhizopus, Apophysomyces, Mucor, and Lichtheimia species, are found in plants, soil, decaying fruits and vegetables, and even in air. If contact occurs with airborne spore, then it germinates into hyphae and is regarded a very rare occurrence. This preferentially takes place inside the bucconasal cavity. After germination, it can invade the neighboring tissue and blood vessels that results in characteristic hemorrhage followed by black color development. The visualization of these dark necrotic tissues on skin and blood vessels of the affected person is termed as black fungus disease. Till now five major forms of mucormycosis have been identified, for example, rhinocerebral (44–49%), cutaneous (10–16%), pulmonary (10–11%), disseminated (6–11.6%), and gastrointestinal (2–11%) forms. Among these, the most common rhinocerebral form usually occurs in immunocompromised individuals. It exhibited a “pattern paranasal infection” with a porch into the oral cavity often. It is a quickly emerging angioinvasive infection, with rhinoorbital-cerebral and pulmonary manifestations. According to the Indian government, there are over 11,700 reported cases and over 126 casualties as of May 2021.[3] There is a surge in terms of infection rates. Though mucormycosis is generally regarded as harmless to an immunocompetent host, it may be fatal in some cases in its combination form with factors like indiscriminate use of steroids or other immunosuppressants, even in subjects presenting with mild symptoms of COVID-19. Immunocompromised patients like people with hematological malignancies, damaged mucosal layer, uncontrolled diabetes, ketoacidosis, and viral induced lymphopenia are the prime victims of this deadly fungus.[4] It is a fatal disease if unnoticed as it is invasive to blood vessels, distant organs, nose, mouth, eyes, sinus, and even brain. If untreated, the infection usually develops speedily, and leads to death within a few days of contamination.