What is and what is not black fungus and how to diagnose short
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Black fungus is in the news for all the wrong reasons
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What is and what is not black fungus and how to diagnose short
- 1. What is & what is Not black fungus ? Prof. Ashok Rattan, MD, MAMS, Common Wealth Fellow, INSA DFG Fellow, SEARO Temporary Advisor, WHO Lab Director (CAREC/PAHO) Advisor: Pathkind Labs Knowledge Forum, R & D and Quality
- 2. Black fungus Melanized (Dematiaceous) fungi • Dematiaceous fungi have high concentration of melanin and melanine like pigments in their cell walls causing a dark pigment • Produce dusky brown to brown pigment in hyphae or conidia cell walls • Both rapidly and slow growing organisms seen • Conidia vary in appearance from single to multi-celled Melanized Hyaline
- 4. Some important black fungi (Dematiaceous) Single cell conidia • Nigrospora • Aureobasidius • Cladosporium • Phoma • Chaetomium Multi-cell Condia • Alternaria • Epicoccum • Pithomyces • Ulocladium • Stemphyllum Pigmented conidia
- 5. Mucor / Aspergillus are Not Black fungi
- 6. Zygomycosis Aspergillosis • Rhizopus • Mucor • Absidia • Others • Aspergillus flavus • A. fumigatus • A. niger • A. terreus
- 7. Fragments of Mucor in blood well Histopathology shows multiple fragments
- 8. Frozen section from Pulmonary mucor infection
- 10. Aspergillus in the lung showing “Y” branching
- 13. When to seek help ? If you have recovered from Covid 19 disease and are now having • 1. Nasal blockage • 2. Blood tinged nasal discharge • 3. Headache • 4. One sided facial pain / swelling / numbness • 5. Toothache, loosening of teeth, discomfort while chewing • 6. Pain in the eye • 7. Swelling of the eye • 8. Double vision
- 16. Appropriate samples • 1. Skin scraping from cutaneous lesions • 2. Nasal discharge • 3. Scraping & aspirate from sinuses • 4. Bronchoalveolar lavage (BAL) • 5. Needle biopsy from pulmonary lesion • 6. Biopsy of involved tissue • 7. Blood culture is not helpful • 8. CSF may be useful
- 17. Initial examination by microscopy 10 – 20 % KOH • Work inside a class 2 biosafety hood • On a clean glass slide place two drops of 20% KoH • With help of sterile needle, transfer clinical material onto it • Spread the material gently with needle • Cover with cover slipe • Heat gently on the underside of the glass slide (optional) • Leave in a moist chamber for 10 to 15 minutes • Examine under low power & then high power
- 18. 10 to 20% KOH Cutaneous Mucor Nasal Mucor
- 19. Aspergillus in KOH, septate hyphae, branching at 45 degrees
- 21. Culture • Dermatophytes grow best between 25 and 30 C • Opportunistic fungi grow best at 30 C • Invasive fungal infection dimorphic fungi grow at 37 C • Use a combination of media • Sabouraud dextrose agar with antibiotics • Brain Heart Infusion Agar • Best in slopes rather than petri dish (to avoid contaminating the lab) • Candida will grow within 48 hours, most by 3 to 4 weeks
- 24. Aspergillus
- 26. Mucor is not a black fungus Maintain high level of suspension in Covid 19 recovered patients who have been treated with Steroids & are diabetic