DEFINITION :

• Mucormycosis is fungal infection of the nose and sinuses.
• Most of the time it proves to be fatal.
• From the nose and sinuses, it rapidly spreads to involve the orbit, cribriform plate, meninges and brain.
• Rapid spread and destruction with this disease is because of the affinity of the fungus to invade arteries.
• Once after its invasion, it causes endothelial damage and thrombosis.
• The typical finding in this disease is the presence of necrotic material.
• Moreover this necrotic material fills the nasal cavity and erodes the nasal septum, hard palate and turbinates.

SPREAD & REASON FOR THE NAME :

• Mucormycosis appeared in second wave of Covid-19.
• Particularly it was found in India when several thousands of this so called ” Black Fungus ” were recorded.
• Though the fungus is not black but so called because of the necrotic material found in the nasal cavities.
• The ” Black Fungus – Mucor ” – is restricted not alone to nose-orbit-brain ( Rhino-orbito-cerebral).
• Moreover it also involves other parts of the body.
• And also it is classified according to the sites of the body involved.

TYPES OF MUCORMYCOSIS :

• Firstly, Rhino – orbito – cerebral
• Secondly, Renal ( Kidney transplant patients )
• Pulmonary ( Patients of lung cancer or found in other organ transplant patients )
• Stomach and intestine type ( invading GI tract )
• Skin type ( Invading damaged skin )
• Finally, Disseminated type

RISK FACTORS :

• Uncontrolled diabetes :
  • The acidic environment that results from the ketoacidosis remains as the favourite environment for the fungal growth.
• Prolonged steroid therapy :
  • Immune suppression produced by the prolonged steroid therapy as in the cases of Covid-19.
• Other cases :
  • Immunocompromised states such as neutropenia, HIV/AIDs,Chemotherapy in cancer or organ transplant patients and kidney problems.

FUNGUS – MUCOR :

• Mucormycosis earlier called zygomycosis belongs to :
  • Class : Zygomycetes
  • Order : Mucorales
  • Family : Mucoraceae
  • Genus : Mucor
• Tissue biopsy visualizes the Hyphae.
• The hyphae are broad, nonseptate and also branches at right angles unlike the hyphae of Aspergillus which branches at 45 degrees.
• Moreover the hyphae takes Methanamine or Periodic Acid Schiff stain.

TREATMENT OR MUCORMYCOSIS :

• Amphotericin B:
  • 0.6 to 1mg/kg/day iv
  • Liposomal amphotericin – 5mg /kg/day till a response is obtained.
  • Moreover the kidney function should also be monitored carefully.
• Posaconazole :
  • Posanole^TM or Noxafil^TM is also effective against Mucor and many other fungi.
  • The one day dosage in Mucormycosis is 300mg twice daily, orally first day and then 300 mg once daily.
  • And also it is available in iv injection and suspension.
• Surgical debridement :
  • Complete removal of the necrotic tissues is essential.
  • In extensive cases, external operations of total or partial maxilectomy or combined with orbital exenteration may be required.
  • Moreover, care of the resultant cavity is essential in the post operative period.
  • And also habilitation with dental prosthetics helps in swallowing.
  • Separate treatment for immuno compromised conditions such as PLAH, diabetes, Neutropenia etc.

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