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Black Fungus: a New Threat Uddin KN Editorial (BIRDEM Med J 2021; 11(3): 164-165) Black fungus: a new threat Uddin KN Fungal infections, also known as mycoses, are Candida spp. including non-albicans Candida (causing traditionally divided into superficial, subcutaneous and candidiasis), p. Aspergillus spp. (causing aspergillosis), systemic mycoses. Cryptococcus (causing cryptococcosis), Mucormycosis previously called zygomycosis caused by Zygomycetes. What are systemic mycoses? These fungi are found in or on normal skin, decaying Systemic mycoses are fungal infections affecting vegetable matter and bird droppings respectively but internal organs. In the right circumstances, the fungi not exclusively. They are present throughout the world. enter the body via the lungs, through the gut, paranasal sinuses or skin. The fungi can then spread via the Who are at risk of systemic mycoses? bloodstream to multiple organs, often causing multiple Immunocompromised people are at risk of systemic organs to fail and eventually, result in the death of the mycoses. Immunodeficiency can result from: human patient. immunodeficiency virus (HIV) infection, systemic malignancy (cancer), neutropenia, organ transplant What causes systemic mycoses? recipients including haematological stem cell transplant, Patients who are immunocompromised are predisposed after a major surgical operation, poorly controlled to systemic mycoses but systemic mycosis can develop diabetes mellitus, adult-onset immunodeficiency in otherwise healthy patients. Systemic mycoses can syndrome, very old or very young. be split between two main varieties, endemic respiratory infections and opportunistic infections. What are the clinical features of systemic mycoses? The clinical features of a systemic mycosis depend on Endemic respiratory infections the specific infection and which organs have been Fungi that can cause systemic infection in people with affected. General symptoms of illness may include fever, normal immune function as well as those who are loss of appetite and weight loss. immunecompromised, include: Histoplasma capsulatum (causes histoplasmosis), Coccidioides immitis (causes How are they diagnosed? coccidioidomycosis), Blastomyces dermatitidis (causes Strong clinical suspicion is vital. The most reliable tests blastomycosis), Paracoccidioides brasiliensis (causes to confirm infection are identification of the organism paracoccidioidomycosis), Talaromyces marneffei from representative sterile specimen; skin biopsy for (causes talaromycosis). These fungi are found in soil histological (microscopic) analysis and fungal culture. and wood debris. Histoplasma is prevalent in Southern Blood can also be cultured. USA, Central America, South America, Africa and Asia. Coccidioides and Paracoccidioides are prevalent in What treatment is available for systemic Southern USA and Central America. Blastomyces is most mycoses? often found in North America. Talaromyces marneffei Once a diagnosis of systemic mycoses has been (formerly known as Penicillium marneffei) is endemic established, the predisposing state should be reversed, in tropical Southeast Asia. if possible; for example by discontinuing immuno- Opportunistic infections suppressing medications or at least reducing their doses. Fungi that only result in systemic infection in Most suitable systemic antifungal medications: immunocompromised or sick people include: amphotericin B, others are fluconazole itraconazole, 164 Birdem Medical Journal Vol. 11, No. 3, September 2021 voriconazole, caspofungin. The prognosis depends on and other immunosuppressive agents and oxygen the patient’s immune function and the extent of infection delivery devices have posed mucormycosis as an when treatment has been started. emerging threat for patients with COVID-19. Casualty is very high, may exceed 50%. Mortality rate due to Black fungus: what is it? gastrointestinal mucormycosisis as high as 85%. It is a systemic fungus, called Mucormycetes causing a disease Mucormycosis. Named “black” possibly Mucormycosis and other opportunistic infections because the affected area become gray or black. among patients suffering and recovering from Mucormycosis is an opportunistic infection which COVID-19 have emerged as a challenging health issue represents the third most common angioinvasive fungal throughout the globe, specially more in infection and is considered as one of the most important India. A case of post-COVID pulmonary mucormycosis medical complications in immunocompromised patients. is reported from Bangladesh. Several factors are Mucoraceae are moulds in the environment that responsible for such an increased incidence of invasive transform into hyphal forms in tissues and invade blood fungal infections among patients recovering from vessels producing tissue infarction, necrosis and COVID-19, which include severe pulmonary alveolar thrombosis. damages in COVID-19 that facilitate fungal invasion, Whom to suffer? immune dysregulations in COVID-19, invasive Patients with diabetes, cancer and transplant recipients mechanical ventilations may facilitate entry of are the sufferer, because of suppressed immunity. It is opportunistic pathogens, so does immunosuppressive not a new disease. In recent days, there is an outbreak, drugs used in COVID-19, prolonged hospital stay and specially, in India with casualties. This is possibly due injudicious antibiotic prescription. to immune suppression incurred by COVID-19 or its How do you diagnose mucormycosis? different modalities of treatments. COVID-19, specially, 1) clinical features 2) CT scan and/or MRI, depending severe COVID-19 is more prevalent among peoples on organ involvement 3) swab from lesion or tissue having diabetes, cancer etc. biopsy specimen and culture; cultures may be negative How does black fungus spread? in 40-50 percent of clinical cases. Likewise, as Mucorales It prevails everywhere in environment, so habitat is are common contaminants of airways, isolation of these cosmopolitan. Fungal spore grows in soil, rotten leaves, organisms from sputum must be interpreted with cow dung, rotten food and may stay in air in dry season. caution. The spore enters the body through nose, mouth and Treatment lungs and the breach of skin. It invades basically those Antifungal drugs: amphotericin B is the drug of choice are immunosuppressed. and very much effective but it is highly expensive. Posaconazole or isavucanazole may be used as Which part of body mostly affected? alternative (fluconazole, itraconazole or voriconazole not Nose, sinuses, orbits, brain (rhinoorbitocarebral effective) infection) are mostly affected; respiratory tract, lungs, Surgery may be life-saving in some cases. gastrointestinal tract and skin may also be affected. Rhinocerebral and pulmonary Follow-up curettage may be essential for some cases. involvements are the two most common forms. Though mucormycosis has been diagnosed since many years, recently large numbers of cases are being identified in patients recovered from COVID-19. Patients with Khwaja Nazim Uddin COVID-19 present with high levels of inflammatory Professor cytokines and associated with impaired cell-mediated Department of Internal Medicine immune response, which lead to increased susceptibility BIRDEM General Hospital, Dhaka, Bangladesh to fungal co-infections. Also, the use of corticosteroids Email: [email protected] 165.
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