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  • 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.
Dark discolouration of right palate and alveolus


  • 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.


  • 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
Destruction of Left Palate


  • 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.


  • 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.
Endoscopic view of necrotic tissue in the right nasal cavity


  • 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 :
    • PosanoleTM or NoxafilTM 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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