Our World is full of single cells to multicellular organisms. These things need survival factors, that is, food. Some groups make their food (Autotrophs), some depend on others (Heterotrophs), and a few make it difficult for others to pick up foods (Parasites). In this twentieth century, all of us face a challenge caused by the new novel Covid-19. Recently, the news has been reported that covid19 stimulates the black fungal disease called Mucormycosis.
Mucormycosis:
Mucormycosis is a fungal disease, and early it is called Zygomycosis. It is a rare disease and affects immunocompromised people and certain diseased patients. It is an Air-borne disease with severe risks. Several types of mucormycosis have occurred. This fungal disease belongs to the group of moulds (mucormycetes) in the order of Mucorales. It is more likely to affect the patient with sinusitis and diabetes and has a mortality rate of 30% to 70%. The report says that the incidence of mucormycosis is much higher in India. It is mainly caused by the inhalation of certain fungal species found in the environment.
Types of mucormycosis:
Mucormycosis is mainly classified into two groups:
1. Superficial – primarily found on the external body.
2. Visceral – mostly found on the internal body.
Superficial:
Rhinocerebral mucormycosis (sinus and brain): It is a common and severe infection. In this rhino, the nasal passage/sinus and cerebral refers to the brain. Destroying the entire area around the eye and nasal and induces tissue necrosis. It has the symptoms of fever, headache, blood discharge in the nasal, proptosis (eye bulges) further, its spread to the brain and lung also leads to blindness. It is more likely to affect uncontrolled diabetes mellitus and immunocompromised people.
Pulmonary mucormycosis (lungs):
Cancer patients, hematologic malignancy and organ transplant people, are more susceptible to pulmonary. This results in angioinvasion, and tissue invasion leads to cavitation.
Gastrointestinal mucormycosis (phycomycosis):
Malnutrition patients and infants are affected by this mucormycosis. It mainly affects the stomach, colon and ileum of diseased people. The symptoms are abdominal pain, gastrointestinal bleeding, nausea and vomiting. Ingestion of moulds of mucormycetes causes this type of fungal disease.
Disseminated mucormycosis:
It mainly affects the brain through the bloodstream and affects organs like the spleen, skin, and heart. Clinical manifestations are headache, fever, visual disturbance and altered mentation.
Visceral:
Cutaneous mucormycosis (skin): The results of trauma like a wound, especially in burn cases, are the victim of this cutaneous mucormycosis. It occurs in two types which are primary and secondary. In prior cases, it produces the acute lesion with pus, tissue swelling and necrosis. In secondary cases, hematogenous seeding produces a painful lesion.
Etiology, Transmission and Risk factors:
Most commonly found on the soil, decaying matters like leaves, plants, foods and minimal amounts in the air. It’ll spread through the air, and three ways mainly cause this type of disease.
1. Inhalation
2. Ingestion and
3. Trauma.
Inhalation is the most common way to cause this disease, and it’ll cause an internal infection like Rhinocerebral, gastrointestinal, cutaneous. Ingestion also causes inner infection by mouth contact with moulds. Trauma causes this infection by natural disasters such as earthquakes, tsunamis because it’ll lead to severe injury or wound on the skin. It causes an external disease, like a cutaneous infection. Once it enters the body, it does not immediately affect the body; instead, it will search for compatible situations like immunocompromised patients and certain diseases.
Risk factors:
The following categories are more susceptible to this type of disease. Immunocompromised patients, uncontrolled diabetes mellitus, ketoacidosis, deferoxamine therapy, burn cases, severe trauma, neutropenia, organ transplanted patients, malignancy, an excessive amount of iron and ammonium, HIV/AIDS, Liver cirrhosis, corticosteroid and immunosuppressive therapy, malnutrition, and chronic kidney disease.
Aetiology:
The most common species are 1. Rhizopus spp. – it causes 70% of the disease and 2. Mucor spp. 3. Rhizomucor spp. Rarely caused by Apophysomyces spp., saksenaea app., Absidia spp (lichtheimia) and Cunninghamella spp.
Pathology:
The three steps employ mucormycosis,
Invasion – It occurs by entering the moulds into the body via wound or external factors.
Angioinvasion – It is a step in which the fungal species enter the bloodstream and reach the desired organs.
Necrosis – In this step, the moulds begin to destroy the tissues of an organ.
Clinical manifestation:
The symptoms of mucormycosis are fever, cough, unilateral headache, facial pain, necrotic lesion on the palate or nasal mucosa, proptosis (eye swelling), nasal congestion, acute sinusitis, epistaxis, chest pain, shortness of breath, erythema, necrotic ulcers, abdominal distension, nausea, vomiting, diarrhoea, Visual disturbance and altered mentation, haemoptysis, haematemesis, cellulitis of eyes.
Diagnosis:
1. Based on the cranial nerve palsy, periorbital pain, inflammation of orbit. Oedema of eyelids.
2. CT scan for fluid-filled ethmoidal (nasal bone) air sinus.
3. MRI scan
4. Microscopy using KOH staining – large non- septate hyphae.
Treatment:
1. Primary treatment is controlling of risk factors
2. Amphotericin B therapy
3. Surgical therapy
How does covid-19 stimulate this infection?
From the overview of mucormycosis mentioned above, these fungal infection’s risk factors also match with the risk factors of covid19, mainly diabetes mellitus, weakened immune system and renal diseases. Covid19 recovered patients may be susceptible to this infection. This leads to the covid19 also a risk factor to the mucormycosis Infection.
