Microcolonial black fungi are a group of ascomycetes that exhibit high stress tolerance, yeast-like growth and constitutive melanin formation. They dominate a range of hostile natural and man-made environments, from desert rocks and salterns to dishwashers, roofs and solar panels. Due to their slow growth and a lack of genetic tools, the underlying mechanisms of black fungi’s phenotypic traits have remained largely unexplored, Nature Scientific reported.
Later City News: Mucormycosis is a rare type of fungal infection that occurs through exposure to fungi called mucormycetes. These fungi commonly occur in the environment, particularly in leaves, soil, compost, and animal dung. Mucormycetes can enter the body through breathing, inhaling, and exposed wounds in the skin, Medical News Today reported.
There are different types of mucormycosisTrusted Source, including rhinocerebral (sinus and brain), pulmonary (lung), gastrointestinal, and cutaneous (skin) mucormycosis.
Respiratory-related symptoms include: cough, fever, headache, chest pain, nasal or sinus, congestion and pain, and shortness of breath.
Skin-related symptoms, which can occur in and spread to any part of the body, include: blackened skin tissue, redness, swelling, tenderness, blisters, and ulcers.
Mucormycosis is not contagious, and most people who come in contact with the fungi do not develop an infection. However, people with severely weakened immune systems are at increased risk of mucormycosis. This includes people with: diabetes, cancer, HIV, skin injury and surgery.
Doctors can treat the infection by administering antifungal medication or performing surgery to remove the affected area. If left untreated, mucormycosis can be fatal, with a mortality rate of 54%, according to the Centers for Disease Control and Prevention (CDC).
How Black Fungus linked to Covid-19?
States across India have reported more than 5,000 cases of the otherwise rare disease in recent weeks, mostly in people infected with COVID-19 or recovering from the disease.
COVID-19 has been associated with a wide range of secondary bacterial and fungal infections, but experts say India's second wave of COVID-19 has created a perfect environment for mucormycosis.
Low oxygen, diabetes, high iron levels, immuno-suppression, coupled with several other factors including prolonged hospitalization with mechanical ventilators, creates an ideal milieu for contracting mucormycosis, researchers wrote in the journal Diabetes & Metabolic Syndrome: Clinical Research & Reviews.
Black Fungus in India
According to experts from the Covid-19 task force, it mostly affects people who are taking medicine for health conditions that inhibits their ability to combat environmental pathogens. After inhaling fungal spores from the air, these people’s sinuses and lungs become infected.
Mucormycetes may not usually pose a significant threat to people who have a strong immune system. Fever, headache, coughing, shortness of breath, bloody vomits, and altered mental state are all warning signs, as are pain and redness around the eyes or nose.
Sinusitis, nasal blockage or congestion, nasal discharge (blackish/ bloody), local pain on the cheek bone, one-sided facial pain, numbness or swelling, blackish discoloration over bridge of nose/ palate, loosening of teeth, jaw involvement, blurred or double vision with pain, thrombosis, necrosis, skin lesion, thrombosis, necrosis, skin lesion, thrombosis, necrosis, skin lesion. Although the number of cases is increasing, there has been no significant outbreak.
At a press conference, NITI Aayog Member (Health) Dr. V K Paul said there had been no major outbreak and that they were monitoring cases registered. Mucormycosis cases are on the rise in Maharashtra, according to Dr. Tatyarao Lahane, head of the Directorate of Medical Education and Research.
In January this year, Dr. Rajeev Soman, an infectious diseases consultant in Pune, wrote in the Journal of the Association of Physicians of India that Mucormycosis emerging in a post-Covid-19 setting breaks the back of a patient’s family that is barely recovering from this viral infection.
Patients most vulnerable to mucormycosis are those who have been treated with steroids and other drugs for Covid 19 to reduce inflammation. According to a report of India Today on May 12, 2021, Thane district in Maharashtra reported 2 more deaths caused by the black fungus.
Moreover, six other patients in Thane are undergoing treatment for the black fungus infection.
Maharashtra health minister Rajesh Tope has said the state could have as many as 2,000 cases of mucormycosis or black fungus. The state government has decided to use hospitals attached to medical colleges as treatment centres for mucormycosis.
Jaipur has seen 14 patients with black fungus infection. Two from Ranchi, four from Rajasthan, five from Uttar Pradesh and the rest from Delhi-NCR have reached Jaipur with complaints of black fungal infection.
Many of them have lost their sight. Odisha reported its first case of mucormycosis in a 71-year-old Covid patient who also has uncontrolled diabetes. The patient, a resident of the Jajpur district, is now undergoing treatment in Odisha. Madhya Pradesh has detected cases of black fungus and two people have already died in the state.
The state has reportedly seen 13 cases of the black fungus. Gujarat has meanwhile reported the highest number of black fungus cases. Gujarat government has started setting up separate wards in hospitals for such patients and has procured 5,000 vials of a medicine used in its treatment. Gujarat has so far reported over 100 cases of mucormycosis, which has left many patients blind.
The black fungus infection was first reported during the first wave of the Covid-19 pandemic in India, typically a couple of weeks afte the patient was discharged. However, in the second wave, patients are reporting the infection even while undergoing
treatment for Covid-19.
Why Black Fungus extended in India?
Reuters reported that unsanitary conditions could increase the risk of developing the infections.
"There is a lot of contamination in the pipes used for oxygen, the cylinders that are being used, the humidifiers used," said Nishant Kumar, an ophthalmologist at Hinduja Hospital in Mumbai.
"If you are immuno-suppressed, and you have been on these pipes and oxygens for a long period of time, then these infections get much more of an opportunity to get in."
But opinion is divided on this point.
"Hospitals were dirty even before April. We need epidemiological studies to assess why these cases are rising now," said S.P. Kalantri, senior doctor and researcher at the Mahatma Gandhi Institute of Medical Sciences in Maharashtra.
A paper recently published by Nature Scientific Report shows that Genetic tools and their application in black fungi are underdeveloped, leaving the genetic bases of their unusual phenotypic features, such as constitutive pigment biosynthesis, yeast-like cell morphology and division, and extremotolerance, unexplored.
In particular, the thick melanised cell walls have represented a hurdle as they hamper the isolation of high-quality macromolecules (DNA, RNA, proteins), the essential uptake of DNA for genetic engineering or the efficient transmission of light required for fluorescence microscopy.
Extremotolerant black fungi most probably evolved specific genes and strategies to survive in harsh environments, and though the sequencing of further fungal genomes will enable the identification of unique genes, genetic approaches such as targeted mutagenesis will be crucial for assigning functions to newly identified genes.
Treatments of Mucormycosis
Mucormycosis may be treated with antifungals, but it will ultimately require surgery. Controlling diabetes, reducing steroid use, and discontinuing immunomodulating drugs are all important, according to doctors.
The treatment involves an IV infusion of regular Mucormycosis may cause the upper jaw and even the eye to be lost. Patients will have to accept the loss of function that comes with a missing jaw, such as trouble chewing, swallowing, facial aesthetics, and self-esteem. If it’s the eye or the upper lip, mechanical substitutes or prostheses may be used to replace them.
Although prosthetic replacement of missing facial structures will begin once the patient has stabilised following surgery, it is crucial to inform him about the availability of such treatments rather than leaving him to worry about the unexpected loss, which will exacerbate a preexisting post-Covid stress disorder.
Prosthetic reconstruction may be done after surgery, but for better long-term results, intermediate solutions should be prepared even before jaw surgery. Prosthetic repair will help to ensure that the treatment isn’t as bad as the disease.
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