Mucormycosis is a life-treating disease, taking the lives of hundreds of people around the world. The disease is caused by a group of molds called Mucormycetes. It is commonly found in areas exposed to mucor mold, especially found in soil, manure, plants, and decaying vegetables & fruits.
Though it is a rare condition and attacks individuals with compromised immune systems, it is crucial to treat the problem as it is potentially life-threatening. Mucormycosis affects people who have certain health conditions that reduce their ability to fight environmental pathogens. Sinuses or lungs in such individuals are infected as they inhale fungal spores from the air. This can lead to serious illness with symptoms like fever, headache, red eyes, cough, and shortness of breath. A patient diagnosed with Mucormycosis requires critical care, rapid diagnosis, aggressive coordinated treatment, and surgical therapy. To that effect, the patient is required to consult with various medical specialists.
How can an ENT Doctor monitor the condition?
An ENT doctor (also known as an otolaryngologist) is a specialist dealing in infection & disorder related to the ear, nose, throat, head, neck & skull. They are trained in the medical and surgical treatment of ear infections, hearing, balance disorders, facial & cranial nerve disorders, tinnitus, and other related conditions.
Some common surgeries performed by an ENT surgeon are tympanostomy, stapedectomy, endoscopy, mastoidectomy, otoplasty, and more. Endoscopy (Sinus and Nasal) is a clinically proven treatment performed in patients with Mucromycosis or black fungus. Endoscopy is a surgical treatment that allows doctors to look at the nasal and sinus passages using an endoscope. The endoscopy surgery is performed in Mucormycosis patients to remove the fungus and dead tissues. In case the infection is spread in the eye or lungs it may require other specialist consultation.
Reasons for the increase in Mucormycosis in Covid-19 Patients
Events that may result in the development of the black fungal infection include:
- Hyperglycemia: caused in patients with uncontrolled diabetes mellitus
- Immunosuppression: caused due to indiscriminate and unmonitored use of steroids.
- Prolonged stay in ICU
- Comorbidities or hematological malignancy post organ transplant
- Voriconazole (antifungal drug) prophylaxis
- Increase in ferritin levels (blood protein)
- Diseases like leukemia, AIDS, kidney and liver conditions, and malnourishment
- Poor sanitation in-hospital medical supplies or home not well sanitized
Signs and symptoms of Mucormycosis
The symptoms of Mucormycosis depend on where the body is infected with the fungus. This may include:
- Facial pain (eyes, nose, teeth, gums, mouth)
- Paraesthesia / decreased sensation over half of the face.
- Black discoloration over the bridge of nose/palate
- Sinusitis – nasal pain / blockage / discharge
- Periorbital swelling
- Blurry vision
- Respiratory problem or breathlessness
- Chest pain, pleural effusion, hemoptysis
- Discoloration of palate
- Toothache, loosening of teeth, jaw involvement
One of the common signs to look for is a skin infection. The infected area can look blistered, red, and swollen – causing inflammation in the patient. If the infection spreads in the brain, the patient may develop signs of mental illness such as confusion, altered mental status, paralysis, and even coma.
It is important to note that the infection may also spread to other areas through blood. This is known as Disseminated Mucormycosis. When this happens, the fungus affects other organs which can be dangerous.
An ENT doctor performs a physical examination followed by another test to evaluate the patient conditions:
- CT Paranasal Sinuses
- CT Chest
- CT Angiography
If you are suspected of Mucormycosis, the ENT doctor will start treatment as soon as possible and prescribe antifungal medications to control the growth of fungus.
Medication and Treatment
There is a three-step approach to treat mucormycosis. Initially, it involves antifungal medications and high doses of antibiotics to control the spread of infection. Some common medication the doctor suggest are:
- Amphotericin B
Surgery is required when uncontrolled diabetes leads to the fungus invading the tissues and stops blood supply. When blood supply is obstructed, the tissues die and create black patches in the affected area. Surgery removes the fungus from the dead tissue, bone, sinus tissue because if left unattended, the fungus can spread to other parts of the body.
Mucormycosis affects the sinus and lungs. A medical and surgical specialty consultation depending on the location of the disease can help to provide the best possible treatment. An ENT consultant is a trained doctor in mucormycosis. Another specialized include:
- Thoracic surgery consultation for pulmonary involvement
- Gastroenterology (GI) surgery consultation for gastrointestinal involvement
- Plastic surgery consultation for cutaneous involvement
In addition, a patient with Mucormycosis must undergo other treatment depending on the area of the body infected. The ENT doctor may be necessary for the management of unstable diabetes, hematology/oncology consultation may be needed for the management of issues related to underlying malignancy, and surgical intensive care unit consultation is important for perioperative care.
Do’s and Don’t For Covid-19 Patients
Here are a few preventive measures you can consider post-covid-19 to avoid infections like mucormycosis.
- Keep doctors informed in case of co-morbidities like diabetes, heart disease, malignancy, or diabetes.
- Tell your doctor if any form of medication being taken like immunosuppressant or immune-related disorder
- Monitor blood glucose level Post-COVID-19 discharge and also in diabetics
- Use steroid judiciously – correct timing, correct dose, and duration
- Use clean, sterile water for humidifiers during oxygen therapy Use antibiotics/antifungals judiciously
- Maintain oral, nasal, and eye hygiene
- Inform the doctor in case you develop to sign
Apart from this, it is critical to identify early signs of mucormycosis. As it helps to reduce the risk of spreading severe infection. If not diagnosed early, the infection can be dangerous. Especially, in covid-19 infected patients who have uncontrolled sugar or suppressed immune system. They must immediately consult an ENT doctor if they develop any signs. They will allow the ENT doctor to monitor the conditions, thus providing early intervention to prevent the progression of severe mucormycosis infection.