You and Me: ‘This Black’ is NOT beautiful!, A commonplace black mould gone berserk!

By Lokmat English Desk | Published: May 10, 2021 07:45 PM2021-05-10T19:45:02+5:302021-05-10T19:45:02+5:30

Dr Mangala Borkar We are all familiar with the greyish mould that develops on bread and other moist foodstuffs, ...

You and Me: ‘This Black’ is NOT beautiful!, A commonplace black mould gone berserk! | You and Me: ‘This Black’ is NOT beautiful!, A commonplace black mould gone berserk!

You and Me: ‘This Black’ is NOT beautiful!, A commonplace black mould gone berserk!

Dr Mangala Borkar

We are all familiar with the greyish mould that develops on bread and other moist foodstuffs, vegetables, dung and grains, especially in monsoons. It is a commonly occurring fungus Mucor mycoses, that is present everywhere, but hits humans when their immunity is low. The therapy in COVID is potentially a double-edged sword and has to be used right, used just enough and under constant vigilance to prevent it from becoming a Bhasmasur. It is not always possible to decrease the duration or dose of therapy, but a watchful eye may at least pick up this black fungus early enough to save the patient.

Dr Sanjay Patne

JJ hospitals

President, Physicians’ Association, Aurangabad.

High index of suspicion is the key

Mucor mycosis is an opportunistic fungal infection seen rather commonly in post-Covid-19 patients nowadays.

Risk factors -

1.Uncontrolled blood sugar.

2. Steroids, especially if prolonged, higher doses are used (especially methyprednisolone)

3.Use of Tociluzumab/etuluzimab .

Mortality overall is very high ie 50-70 %, if it spreads. So, do not waste time. Though symptoms are commonly found in nose, sinuses and eyes, the brain also may be affected, with severe headache, or paralysis.

The lungs and abdomen involvement may present with cough or diarrohea.

Diagnosis - Scraping of lesion for microscopy, CT sinuses.

Prevention –

* * * * *By judicious use of steroids,

·Strict Diabetes control

·Use of sterile water in O2 humidifier

·Frequent cleaning of O2 mask and changing the tubes

·Good personal hygiene.

.

Treatment -

·Anti-fungal injections (liposomal amphotericin B is preferred, 5mg/kg/day) for 2-3 weeks, with oral anti-fungal medicines like Poseconazole..

Early surgical removal of infected tissue is the cornerstone of treatment.

·Co-morbidities like diabetes should be treated aggressively and haemoglobin attempted to be kept above 10. Iron overload if present should be reduced with chelating agents as the fungus thrives on iron.

·Dr Amol Sulakhe

ENT specialist, Kamalnayan Bajaj Hospital

EARLY DIAGNOSIS is the key to save life

·Early diagnosis can happen if the doctor or nurse is observant and pays heed to apparently minor symptoms. The patient has mostly recovered from critical COVID and received many drugs and oxygen. May have been in ICU for a prolonged time.

Symptoms

·Clinical features resemble sinusitis, but nasal discharge is often blackish.

* * * * *Nasal congestion/crusting

* * * * *Headache

* * * * *Sinus /Facial/Dental pain

* * * * *Facial numbness/swelling

* * * * *There may be a characteristic 'black eschar' inside the nose that can be seen on nasal endoscopy.

Diagnosis

* * * * *Nasal Endoscopy (bedside)

* * * * *Nasal swab for KOH mount/fungal stain to confirm diagnosis

* * * * *MRI/CT of para nasal sinuses with brain to pick up early involvement of sinuses and know the extent of bony destruction and spread.

Treatment -

Severe disease may need extensive surgery. Early cases can be treated with anti fungal injections and tablets with minimal surgical debridement.

Dr Manoj Saswade

Retina Specialist.

Saswade Netra Rugnalaya.

Don’t ignore minor symptoms!

Both the treating doctors and COVID patients themselves (where feasible) have to be very watchful. Do not ignore minor complaints like pain or swelling on face/eyes/mouth and teeth in critical patients of COVID in ICU or those who have recently recovered. Usually, the fungus enters through the nose and infects the mouth or sinuses (hollow bones around the nose).

Symptoms

·Initially, the patient may have swelling around an eye, or numbness or a sinus tract on face, nose congestion/ crusting inside.

* * * * *Headache

* * * * *Sinus /Facial/Dental pain

* * * * *Facial numbness/swelling

·Some may show discoloration of skin or infection on cheek or around mouth.

Common signs in eyes -

·Sudden loss of vision (due to central retinal artery occlusion)

·Double vision

·Protrusion of eyeball

·Drooping of eyelids

Diagnosis

Nasal swab for KOH mount is diagnostic.

CT of sinuses is more practical than MRI in COVID.

Treatment

Extensive surgery including removal of eyeball may be needed.

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