Today, we are living in an age and world where in we are constantly surrounded by entities that are completely invisible to our naked eyes. Yet, these small machineries of mass deaths and chaos are wreaking havoc in today’s present scenario. Hence, it is imperative that we have a sound knowledge of such entities. One such entity are the microorganisms. These microscopic level beings have brought the world and our day to day lives to a stand-still. Since times immemorial human kind has encountered many of these microorganisms and they have always shown that 1 minute entity can bring whole of human kind on its knees if not taken a proper care of.

Human race has time and again faced epidemics and pandemics like Ebola, AIDS, Typhoid, etc. Currently the whole world is facing and going through the worst pandemics of all time i.e. COVID-19. India has been the centre of this pandemic for the latter part and is receiving severe brunt of this deadly virus. Although we are slowly but steadily winning this fight against the Coronovirus, India as a country could potentially be facing another epidemic which is Mucormycosis. This infection if not controlled in a timely manner could result in more fatalities in an already immune weakened country and could burden the already collapsed healthcare system.  Therefore, it is our responsibility as microbiologists to inform the general population about Mucormycosis and how we could stop the spread of this entity.

So what is Mucormycosis? According to the Centers for Disease Control and Prevention, Mucormycosis is a serious but rare fungal infection caused by a group of molds called mucormycetes. As we all have been hearing about this infection from the news bulletins, this infection usually affects the people who have health problems and co-morbidities or have been taking medicines like steroids that significantly lower the body’s ability to fight germs and sickness i.e. people with weaker immune systems. The most commonly symptoms of Black fungus are excessive running nose, swelling or pain behind and around the eyes, dark spots around the nose, blurred or a complete loss of vision.

Usually the mucormycosis is of 5 types viz. 1] Rhinicerebral wherein the infection in sinuses may spread to the brain 2] Pulmonary or Lung wherein people with diseases like cancer or organ transplant patients are infected 3]Gastrointestinal which is more common in children 4]Cutaneous or skin type wherein the fungus enters the body through breaks in skin caused by burns or trauma 5] Disseminated type wherein the infection spreads through the blood stream. Mucormycosis or more commonly referred to as Black fungus usually infects people with an impaired immune system, or damaged tissues. Use of drugs which suppress the immune system such as corticosteroids can lead to impaired immune function. This is the major reason why people with comorbidities or patients who have recovered or suffered from Covid-19 are the most targeted by this black fungus or mucormycosis as these patients are on constant medications. Also patients who have recovered from Covid-19 have suppressed immune systems and weakened lungs, which is a gateway for the spores of the fungus to enter our airways or sinuses and grow and then invade our tissues.

Mucormycosis can manifest in the lungs, but the nose and sinuses are the most common site of mucormycosis infection. From there it can spread to the eyes, potentially causing blindness, or the brain, causing headaches or seizures. People with diabetes and obesity tend to develop more severe Covid-19 infections. This means they’re more likely to receive corticosteroids, which are frequently used to treat Covid-19. But the corticosteroids – along with diabetes – increase the risk of mucormycosis. Meanwhile, the virus that causes Covid-19 can damage airway tissue and blood vessels, which could also increase susceptibility to fungal infection. So damage to tissue and blood vessels from Covid-19 infection, treatment with corticosteroids, high background rates of diabetes in the population most severely affected by the coronavirus, and, importantly, more widespread exposure to the fungus in the environment are all likely to be playing a part in the situation we’re seeing with mucormycosis in India.

Black fungus grows in our nasal cavities and penetrates our tissues wherein it starts to damage bones in our orbital, nasal and skull plates. Growth of black masses may be observed and if it destroys the orbit and enters the eye socket it may cause bulging of the eyes, pain, frozen eye movements, and blindness. Once it enters the cranial cavity by breaching the skull base it blocks major arteries and veins resulting in major life-threatening brain strokes and bleeding. Tissue biopsy and CT scans of lungs, sinuses or parts that may have been affected by mucormycosis are the ways to determine if the person is infected or not. 

While black fungus is spreading in India, White fungus infections have also been reported in some parts of our country. White fungus is more severe than black fungus as it shows Covid like symptoms of low oxygen levels, chest pain and cough apart from whitish patches in the oral cavity, white discharge and skin lesions which are characteristics of white fungus infection. It is more severe as it affects vital organs like lungs, kidney, brains and private parts too.

Both Fungal infections can be fatal and hence it is important as a part of the community to stop these infections being the cause of an epidemic in India. It is not that the immunity of the people is too low or worrisome, but the people who have diabetes already have higher sugar levels. Also the patients who have recovered from Covid-19, their bodies have a higher amount of activated immune machineries due to fighting the Covid-19, and hence to bring these levels to normalcy, steroids are being used which promotes the elevation of sugar in our bodies. We should be mindful of both these conditions as the ketones in sugar are the area where such fungi target, as their enzymes metabolize such ketones and hence promote the growth of Mucormycosis.

We as community need to be aware about the over dosage or usage of such steroids and must maintain a healthy lifestyle so that the sugar levels are kept in check. Mucormycosis or Black/White fungus is nothing to get scared of as it is completely curable. It is our responsibility as common people to be aware of the symptoms and if detected, visiting the doctor who can treat these infections with as simple drug as Amphotericin. It should be made clear that it not only due to errors in medical fields that are driving the cases upwards as such fungi are present all around us in soil, or rotting food and fruits etc. All we need to do is make some positive lifestyle changes, bring in a positive attitude and take care of our mental wellbeing by not getting scared as Mucormycosis is completely curable by doing the basics right like sanitation, keeping sugar levels in check, being mindful of what we are putting inside our bodies in form of medications in what quantities and how much of a duration and strengthening our immune systems by proper intake of food and fluids. There is a lot of research going on in healthcare field that is only going to pave way for a better and happy days for all of us in the future. We only need to trust our systems in place and beat such pandemics and epidemics by uniting as a community and helping people who are in need in such difficult times.