Mucormycosis: a deadly complication after COVID

The fact that COVID-19 causes complications in many cases is a fact confirmed by numerous examples. Most often, those who have been ill for several months after recovery are tormented by muscle pain, fatigue, and problems with the respiratory system. Some people experience depression and anxiety after COVID-19. But what is happening now in India, no one expected. There, those who have recovered from COVID-19 develop a complication in the form of mucormycosis, a fungal disease that leads to blindness or even death. At the beginning of summer, the number of cases in the country exceeded 11 people. The figure continues to grow rapidly. And this despite the fact that before the second wave of the COVID-000 epidemic in India, isolated cases of mucormycosis were recorded per year. Even less so in more developed countries.

What is mucormycosis

Mucormycosis is a fungal disease that the media has already dubbed “black fungus” (because of the black spots that cover the dead tissue on the patient’s body). Even before the start of 2021, the disease was extremely rare, and now it is one of the most common complications of COVID-19 in India. The causative agent of mucormycosis (Mucoralean mushrooms) is able to penetrate into the sinuses, affect the mucous membranes of the eyes and even the tissues of the lungs and brain. If the spread of the fungus is not stopped at an early stage, 50-80% of patients will die.

Mushrooms originated on Earth about 400 million years ago and their benefits to the planet are undeniable. They help plants get minerals from the soil, decompose organic residues, process nutrients contained in wood and leaves. But some species of fungi in the course of evolution have acquired the features of pathogens. Only some of them are dangerous for humans. The reason is that humans evolved to have a complex immune system that protects its host from pathogens. But if the immune system is weakened, fungi that were previously harmless to humans penetrate the tissues of the body, causing life-threatening diseases.

Under normal circumstances, Mucoralean fungi of the genera Mucor and Rhizopus, which are all familiar molds, live in soil, compost, manure, plant waste, and rotting wood. They also form black mold spots on spoiled fruits and bread. These fungi reproduce by spores. The humid tropical climate, like in India, is ideal for mold growth.

Mucormycosis occurs when an immunocompromised person inhales Mucor spores. ^[1]. It is not a contagious disease and only affects people with impaired immune systems. Until recently, people who underwent organ transplantation were identified as the main risk group, since these patients take immunosuppressants that prevent rejection of the transplanted organ, but at the same time weaken the body’s immune response. Also, people suffering from HIV / AIDS, oncological diseases, and congenital diseases of the bone marrow are more susceptible to mucormycosis. Now, experts have added patients with COVID-19 to this group.

Symptoms of the disease

The most common symptoms of mucormycosis are:

• nasal congestion and/or bleeding;
• Pain in the eyes;
• swelling of the face;
• headache;
• ptosis (drooping eyelids);
• deterioration, and then complete loss of vision.

If the fungus infects the lungs, there is a cough, shortness of breath, fever ^[1]. The progression of the disease can lead to necrosis of areas of the brain ^[2].

In addition to respiratory symptoms, infected people may also develop blisters and sores on the skin, black tissue (most often in the nose area), which is why the disease is called “black fungus”.

According to Indian doctors, patients usually seek help when the disease is severely advanced. Therefore, most often, to prevent infection from entering the brain, the patient has to remove one or both of the affected eyes, in some cases the jaw. But also in the country there is a high percentage of deaths from the disease. ^[3].

You can avoid such serious consequences if you seek medical help in a timely manner and undergo adequate therapy.

For the treatment of mucormycosis, antifungal drugs are used, which must be administered intravenously daily for 2 months.

What is the relationship between COVID-19 and mucormycosis

At the beginning of 2021, mucormycosis as a complication after COVID-19 was detected in only 8 people: three in the US, two in India, one each in Italy, Brazil and the UK ^[4]. Today, the number of cases exceeds 10.

According to doctors, the reason why people who have recovered from COVID-19 become a target for fungi of the Mucoraceae family is taking steroids. Drugs of this group are actively used to treat patients with a severe course of coronavirus disease. Steroids effectively eliminate severe inflammation of the lungs, but at the same time they lead to a decrease in immunity. In addition, against the background of steroid therapy, blood sugar may increase. And diabetes, according to researchers, is another risk factor for developing mucormycosis. ^[1]. Diabetes is dangerous not only because it weakens the immune system, but also creates conditions in the body that are favorable for the development of fungal infections. ^[5].

By the way, according to experts, it was the high incidence of diabetes and the rapid spread of coronavirus that served as the main factor in such a high rate of complications in the form of mucormycosis. ^[6].

According to Indian doctors, mucormycosis usually occurs about 2 weeks after recovery from COVID-19 ^[3]. According to the study ^[7] The main triggers for the development of mucormycosis after suffering COVID-19 are:

• diabetes mellitus and diabetic ketoacidosis;
• uncontrolled hyperglycemia while taking corticosteroids;
• low pH (acidosis);
• a decrease in the phagocytic activity of leukocytes while taking steroids;
• endothelialitis (damage to the endothelium), thrombosis, lymphopenia, which often occur against the background of COVID-19 and make a person vulnerable to the addition of a secondary or opportunistic fungal infection;
• increase in the amount of free iron in the body.

The rapid rise in cases of mucormycosis in India as a complication of COVID-19 is the result of a combination of three factors:

• widespread diabetes in the country;
• uncontrolled use of corticosteroids;
• non-compliance with quarantine measures, which led to a massive infection with coronavirus.

Mucormycosis is a rare disease, and mushrooms of the Mucoraceae family are generally safe for individuals with strong immunity. And this means that it is possible to protect yourself from the disease if you maintain a healthy immune system, monitor the state of blood sugar and strictly follow preventive measures against COVID-19.

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