Mucormycosis, known as black fungus, is a fulminant fungal infection. It occurs only when a person's immune system is compromised. Organ transplant patients, cancer patients, those with immune deficiencies, long-term steroid users, and uncontrolled diabetics are at risk for this infection.

1. Mucormycosis / Black Fungus
Infection
What is mucormycosis black fungus infection?
Mucormycosis, known as black fungus, is a fulminant fungal infection. It occurs only when a
person's immune system is compromised.
Organ transplant patients, cancer patients, those with immune deficiencies, long-term steroid
users, and uncontrolled diabetics are at risk for this infection.

2. COVID-19 patients also have a higher risk of getting black fungus. The risk gets higher when a
person has one of the above conditions.
Mucormycosis is curable when detected in its early stages, but it becomes more difficult to
cure if identified in its later stages. So to prevent this disease, it is essential to manage
diabetes, as it is the most common cause of mucormycosis.
How do we get black fungus?
Mucor is a fungus that causes this disease.
Mucor develops on dead matter and is black in color. It thrives on decaying foods and dead
organisms and is found in our atmosphere.
Mucor is found everywhere and enters our bodies daily, yet our immune systems are capable
of combating it.
It can only impact us if our immunity is compromised. It can cause problems with the nose,
sinuses, and other nearby structures.
Who can get black fungus?
Fulminant fungal infection can occur only when immunity is deficient. Here is a list of patients
who can get black fungus.
·Organ transplant patients on immune suppressants
·Cancer patients on anti-cancer drugs
·Immune deficiency syndromes Eg: AIDS
·Patients who are on steroids for months
·Uncontrolled diabetic patients
Uncontrolled diabetes is generally the most common cause as it is the most common
condition among the above-stated conditions.
Who can get black fungus if affected by COVID-19?
The chance of getting this disease increases when the above patients get COVID-19. Although
most of the patients had diabetes, some had none of the underlying conditions other than
COVID-19. A significant chunk of people didn't require any hospitalization or oxygen support.
You can find more details in Mucormycosis after COVID section of this article.
Treatment of mucormycosis

3. Treatment of mucormycosis requires a combination of surgical removal of infected tissues
and antifungal medication to stop the growth of fungus in the body.
Treatment for this disease can go on for 15 to 40 days, depending on the diagnosis's timing
and the patient's immunity.
Typically the survival rate is 90% if identified early only.
The treatment of mucormycosis must be started on suspicion to keep the survival rate high.
Waiting for a few hours to confirm the tests can give the fungus time to double and change
the person's fate.
Black fungus in late stages
If you identify late-stage, most doctors don't see a point in the treatment as, most likely, the
fungus will attack the brain bringing down survival chances to as low as 5%.
It will unnecessarily create pain and financial loss for the patient and give the patient and his
family unnecessary hope.
The author says he doesn't take in patients with fungus spread to both eyes or brain or
multiple organs in the face.
He believes that the recovery of such patients will be a miracle he has never witnessed
personally or hasn't heard of the recovery to date from his colleagues and would rather leave
them untreated and ask them to spend their last days with their loved ones.
However, few books state a single-digit percentage chance of recovery.
Dr. K. R. Meghanadh says it would involve the removal of multiple organs in the face and
would leave a heartbreaking image of the loved ones to their family in their final days.
The chance of survival is so low that it is not worth taking risks.
This is Dr. K. R. Meghanadh's opinion as a doctor, but opinion could vary from doctor to
doctor as it is a matter of choice.
Dr. K. R. Meghanadh has observed that COVID-19 patients were recovering a shade quicker
when compared to patients before COVID-19. Unlike diabetes, cancer, or AIDS, recovery time
in COVID-19 is less, and the patient's immunity gets better quickly.
Due to the shortage of expert ENT doctors in mucormycosis, Dr. K. R. Meghanath saw many
recurrent cases. Treating recurrent cases is tougher than first-timers as the patient's body
has already gone through the vigorous medication of powerful antifungal drugs. The body will
be a bit more sensitive than the first time. Please read this article for more details.
Recurrence of Mucormycosis due to partial treatments

4. Why is it deadly?
Black fungus infection is a fulminant type of fungal infection that spreads through the blood
vessels rapidly. It doubles up its presence every few hours. It spreads from the nose to the
sinuses in a few days and the eyes and jawbone in a couple of days. When it ultimately
spreads to the brain, the survival chances are negligible, and a doctor might deny taking up
the case. The speed, however, depends on the immune status of the patient. This is why
doctors start antifungals on suspicion of the disease and do not wait for confirmation.
Precautions for black fungus
The most common underlying disease or reason for black fungus infection in patients
irrespective of COVID-19 is due to diabetes. In fact, few metrics say that mucormycosis cases
per million people in India are much higher than in the rest of the world. A major reason could
be that India has a very high percentage of people who have diabetes, and the majority of
them are uncontrolled. Controlling diabetes can help in reducing the changes in black fungus
cases.
Precautions for COVID-19 patients
We can prevent this by controlling COVID-19 with antivirals like favipiravir or molnupiravir at
the very early stage, which can help slow viral infection and decrease the viral load in the
body thus trying to keep the immunity of the person intact.
N95 mask can block the black fungus seeds very effectively. Wearing an N95 mask during and
continuing after a few weeks of the infection can exponentially reduce the mucormycosis
risk. You must remove the mask only when necessary, i.e., eat or drink. People who can get
black fungus must follow this when affected by COVID-19.
Mucormycosis fungal infection symptoms
· A very severe pain in the cheekbone, teeth, eye, or head, which cannot be relieved by regular
painkillers - the first symptom observed
·Black nasal discharge
·Double vision
·Deterioration of eyesight
·Swelling of eye, nose, or cheek
·Watering of the eye
·redness of the eye

5. Mucormycosis or black fungus infection spreads rapidly compared to other fungal infections,
and the same goes for symptoms. Most of the fungal sinus infection symptoms are similar.
They appear to progress rapidly in black fungus.
Starting Symptoms of Black Fungus
It is crucial to recognize the starting symptoms of black fungus, especially for people with
very low immunity. Knowing the symptoms can be a life-saving tip, especially during a
pandemic when people's immunity is compromised.
The starting symptom of black fungus is severe facial pain, which could manifest as pain in
the cheekbones, teeth, or head. It is the first and only mandatory symptom of mucormycosis
and is sufficient for early detection.
If left untreated, black fungus can spread rapidly to the cheeks, eyes, and brain, leading to
death. Therefore, seeking immediate medical attention at the first sign of severe facial pain is
essential. When the patient visits the doctor at this stage, the survival chances are as high as
90%. As days pass the percentage keeps getting lowered.
Other symptoms of mucormycosis are mentioned in the above section, and all these
symptoms need not appear like this first symptom. Only a few symptoms might appear
depending on which part of the face the fungus spreads. Therefore, it's crucial to be aware of
the primary symptom and seek prompt medical attention when it appears. Suppose the
infection spreads to the brain before spreading to the eyes. In that case, symptoms like
double vision, swelling of the eye, redness of the eyes, watery eyes, and deterioration of
eyesight might not even appear. Black nasal discharge is a very rare symptom. Unfortunately,
the late symptoms are more known to the public than the first important ones.
How to diagnose mucormycosis?
Even if we have one symptom mentioned above, we must consult an expert ENT doctor who
will conduct a nasal endoscopy. If the doctor finds a black material inside the nose, there is a
high probability of having mucormycosis. A small sample of the black material is scraped and
sent to culture and biopsy to prove the diagnosis. Still, the doctor will start the anti-fungal
medication even before the culture results as a precautionary measure.
Mucormycosis after COVID
The author was among a few ENT doctors in Andhra Pradesh and Telangana who treated
mucormycosis black fungus infection cases before the COVID-19 pandemic. You cannot
credit this to his talent or experience but to the rarity of this disease. Pre-COVID in more than
20 years, he has hardly seen five to ten cases per annum. So, only a few ENT doctors are used
to treat fulminant fungal infection cases. If every ENT doctor in the state or world wanted to
treat mucormycosis, then no one would be an expert, and it is patients who would suffer the
most. In India's first wave of COVID-19, he saw around 30 patients. During the second peak of

6. COVID-19 in India, he saw a minimum of five patients daily despite the increase in ENT
doctors treating mucormycosis. The author witnessed more than 500 cases and treated 170
patients during the COVID-19 second wave. The author was worried about seeing the alarming
increase in mucormycosis patients due to the speed of the fungus progression and success
rates. On May 9th, 2021, Dr. K. R. Meghanadh said, Omicron thankfully didn't affect immunity
as much as Delta and Alpha did. The hospitalization rate in Omicron cases was negligible, and
most of the patients were admitted due to some other complications. In the third wave
driven by the Omicron virus, Dr K. R. Meghanadh didn't get any post-COVID mucormycosis.
COVID-19 attacks the immune system. When a patient has any of the above five conditions,
the possibility of having mucormycosis post covid rises. But, we have observed that most of
the mucormycosis patients who got post covid have diabetes. However, there were patients
without the above conditions and only COVID-19, including two kids (2 and 8-year-old boys).
The doctor must give every antifungal injection like conventional Amphotericin-B in the form
of an IV, which can take up to 8 hours for the dose. The hospital must give the antifungal dose
only in the ICU, which has restricted the intake of mucormycosis-infected patients during the
second wave of COVID-19 in Dr. K. R. Meghanadh's hospital. They can take only three patients
per ICU bed, and they had no scope to compromise. Every patient will take from 20 to 40
days of treatment which made expert doctors reject many patients as taking extra patients
would mean a compromise on both already admitted patients and patients being admitted.
Keeping the disease progression in mind, they cannot wait for other patients' discharged to
admit a new patient. So, ENT doctors who had minimal experience and knowledge of the
shortage of time and beds with experts in mucormycosis had to take up these cases and it
was the best choice to keep the patient alive in the given crisis. Although it knowingly meant a
higher chance of recurrent mucormycosis for the patients admitted than the expert doctor.
Myths on black fungus infection
There is a lot of misconception in the public that we have to look for changes in the eyes to
detect mucormycosis, or a person with mucormycosis will have red eyes or swelling in the
eyes. There were rumors that we needed to check our noses for black discharge. However,
both of these are mucormycosis fungal infection symptoms. These are not the first
symptoms, the first symptom is severe facial pain, and a patient must consult a doctor before
these symptoms appear. Nasal discharge is an infrequent symptom.
During the second wave of COVID-19, many media and social media channels were behind
why mucormycosis black fungus infection cases were only in the Indian subcontinent. This
led to giving out many theories with the help of a few ENT doctors, few could have some
weight, but most of them are false. This is because most doctors don't have prior experience
with mucormycosis due to the rarity of the disease. The books they read might also be
insufficient. The disease is so rare that witnessing a black fungus disease during the PG of an
ENT doctor is super rare, and if the doctor is exposed to even one patient with this disease,
he is considered lucky.

7. There is a myth that steroid medication taken for COVID is the cause. Steroids taken for a few
weeks do not impact the immunity to a considerable amount. So steroids taken for COVID
treatment under an expert doctor for a few days will not tend to cause mucormycosis.
Oxygen has nothing to do with mucormycosis. Many media channels have reported that black
fungus could be due to unhygienic oxygen pipes, cylinders, or the use of industrial oxygen.
Check out our article "Don't link Mucormycosis / Black Fungus and Oxygen Cylinders."