Health

Health / Black Fungus (Mucormycosis) What’s the Risk?

DR SAURABH KAMAT

As Goa finds its way out of the second wave of Covid-19, doctors are slowly encountering the after-effects of the wave, even as we wait for the tide to turn and vaccination to catch up. The Government of Goa and the medical fraternity as a whole has been working tirelessly to tame the spread of this deadly virus.

One such prominent postcovid manifestation is that of ‘Mucormycosis’ also known as ‘Black Fungus’. Mucormycosis is a fungal infection that has a high mortality rate of 50 per cent and an increasing number of Covid-19 patients have been developing this infection while still at the hospital or after discharge.

The success of treatment for Mucormycosis hinges on early detection and awareness amongst general public about the signs and symptoms of this black fungus. The cardinal symptoms include sinusitis, blackish nasal discharge, multiple oral sinuses with pus discharge (Fig.1), mobile teeth, facial pain, headaches, and pain around the eyes.

Both symptomatic and asymptomatic patients with Covid-19 may be at risk.

Patients who have been hospitalised for Covid-19 and particularly those who require oxygen therapy during Covid-19 illness are at a much higher risk of mucormycosis.

Patients with uncontrolled diabetes are at a higher risk of mucormycosis because the high blood sugar levels make it easier for the fungi to grow and survive, and their weaker immune systems offer less protection against the infection.

Corticosteroids given for the treatment of Covid-19, leads to a further rise in their blood sugar levels; thus increasing the risk of mucormycosis. This combination of diabetes and Covid-19, therefore, becomes a dangerous and deadly challenge to manage.

Symptoms of mucormycosis may appear non-threatening at first. But it is important that patients, their caregivers, dental surgeons or family physicians recognize these early and get the treatment required to contain the situation. The important thing is that patients speak to their doctor and follow-up if they experience any

Fig.2 Dr. Saurabh Kamat explains about Mucormycosis and what can be done in case a person develops it

Fig.1

of the symptoms mentioned in ICMR Advisory on Mucormycosis (Fig.2).

Early imaging includes contrastenhanced MRI and CT scan of the face and head (Fig. 3), which is helpful in assessing the extent of involvement of this lethal disease, which requires prompt and aggressive treatment. Deep nasal swab for KOH (Potassium, Oxygen, and Hydrogen) smear, fungal culture and biopsy of the lesion helps in confirming the diagnosis.

A multi-disciplinary approach is required for management of RhinoOrbito-Maxillary Mucormycosis. The team includes oral and maxillofacial surgeon, ENT surgeon, ophthalmologist, neurosurgeon and infectious disease specialist.

Surgery is aimed at aggressive clearance of the pathologic tissue (Fig.4) to make healthy bed for perfusion of anti-fungal therapy. A maxillofacial surgeon plays dual role of removing the diseased jaw bone as well as postmucormycosis reconstruction and dental rehabilitation. ENT surgeon performs endoscopic sinus surgery for sphenoid, ethmoid and maxillary sinus. Ophthalmologist decides the orbital clearance and removal or preservation of the diseased eye whereas neurosurgeon manages the osteomyelitic skull bone and affected brain tissues. The first line of antifungal therapy in mucormycosis is the use of Amphotericin B.

General dental practitioners can play a key role in management of this outbreak of fungal infection and can act as an important part of the team by making early diagnosis and referring the patient at the earliest to minimize morbidity as well as mortality.

Strict monitoring and maintenance of blood sugar levels by patients under their physicians’ guidance can prevent mucormycosis. Hygiene maintenance of the oxygen mask, oxygen delivery system and use of distilled water in humidifiers also aids in prevention.

Post-Covid patients need to maintain oral and nasal hygiene and have a high protein-low sugar diet. Moreover, patients need to avoid long term usage of disposable or soiled N-95 masks.

The Team of Oral and maxillofacial surgeons at Goa Dental College and hospital headed by Prof. Dr. Vikas Dhupar and ably supported by Prof. Dr. Francis Akkara, along with their team members from Goa Medical College and Hospital have been keenly observing the post-covid patients for early detection and rendering prompt surgical and medical treatment necessary to stop the menace of Mucormycosis.

A collective effort by all in raising awareness about mucormycosis in Goa would definitely serve the cause of humanity and reduce the suffering that it causes to the quality of life

Fig.3

< Continued from Page 45 Flights of Fancy

but I haven’t as yet”

The top sites for bird watching in Goa are Baga fields, Bhagwan Mahaveer Wildlife Sanctuary-Tambdi Surla and Mollem, Bondla Wildlife Sanctuary, Chorao Island and Mayem Lake, Carambolim Lake, Morjim Beach, and Saligao Zor are places where one can spot a wide variety of birds. Goa has a few reserves like the Dr Salim Ali Bird Sanctuary at Chorao, named after the eminent Indian ornithologist, Mollem and Bhagwan Mahaveer Sanctuary,

Dr. Saurabh Kamat is an Assistant Professor, Department of Oral & Maxillofacial Surgery at Goa Dental College and Hospital. He is also a Fellow of Indian Board of Oral and Maxillofacial Surgery (FIBOMS) and Fellow of International Board for Certification of Specialists in Oral and Maxillofacial Surgery (FIBCSOMS)

Bondla Wildlife Sanctuary at Ponda, Cotigao Wildlife Sanctuary, Mhadei Wildlife Sanctuary, and Netravali.

Birding is the opposite of being at the movies – you’re outside, not sitting in a windowless box; you’re stalking birds, not looking at pictures of them. You’re dependent on weather, geography, time of day – if you miss sighting a particular bird, there isn’t a midnight showing. On the other hand, birding, like moviegoing, is at heart voyeuristic, and you can’t do it without technology – to bring birds closer you must interpose binoculars between yourself and the wild world. Birds are natural; birders aren’t