What Is Mucormycosis? India Sees Potentially Fatal Fungal Infections Rise During COVID-19

The infection mainly affects people who are immunocompromised.

Concurrent with the COVID-19 pandemic, India (and elsewhere in the developing world, to a lesser extent) has seen an increase in cases of mucormycosis, a potentially deadly fungal infection. While rare, the condition can develop in any location, mainly affecting people whose health is compromised. Here's what you need to know.

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What Is Mucormycosis?

Mucormycosis is a serious but rare fungal infection caused by a group of molds called mucormycetes, according to the Centers for Disease Control and Prevention (CDC). While the infection itself may be uncommon, the molds themselves are not, living in soil, leaves, animal waste, and rotting organic matter, including vegetables, fruits, and bread.

"The fungus that causes (mucormycosis) is in the environment everywhere you look," said infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security.

People usually develop mucormycosis after breathing in the fungal spores from the air, which then get into their sinuses and lungs, said Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo in New York. However, it's also possible to contract it through a cut or burn in the skin, said Cindy Wassef, MD, assistant professor at the Rutgers Center for Dermatology. It is not transmissible among people and animals.

Despite the abundance of these molds, the infection mainly affects people who have serious health problems or who take immunosuppressant medications, according to the CDC.

"Infectious disease doctors are familiar with it, but it is rare, fortunately," said William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine. In the United States, for example, the CDC says it investigates one to three clusters per year linked to certain groups of people, such as those who have had an organ transplant.

Most commonly, it affects the nasal passages and eyes and can be treated if caught early, according to a 2022 study published in the Journal of Global Health (JOGH). Sometimes, it kills off vascular tissue, earning its nickname, "black fungus." The second most common form attacks the lungs.

Impact in India

The infection has flourished in India following the first case, identified in December 2020, and its presence alongside COVID-19 has sounded alarms for healthcare professionals. "The national and international reports of the perpetually increasing incidence of COVID-19-associated mucormycosis in recovered or active patients all over the country have led to healthcare professionals fearing an endemic alongside a pandemic," according to the JOGH study.

Several factors may be to blame for the quick rise in the country's COVID-19-associated cases, according to a 2022 study published in the Journal of Family Medicine and Primary Care. First, the virus decreases immunity, making patients susceptible to infections. People are most at risk of contracting the infection when they're immunosuppressed—and that can happen after or during a serious illness like COVID-19. "We see it sometimes after severe influenza," said Dr. Adalja.

Second, the use of steroids and monoclonal antibodies in the treatment of COVID-19 may further suppress immunity. In a 2021 study published in the journal Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 76.3% of the mucormycosis cases reviewed had used steroids as part of their treatment for COVID-19.

Third, poor disinfection of humidifiers and non-sterile water in industrial oxygen containers, both used for the treatment of COVID-19, may be creating ripe environments for molds to grow.

As in other places, many of the patients in India have had comorbidities that prime them for contracting mucormycosis. Diseases such as diabetes, cancer, and heart disease may increase the risk of contracting mucormycosis during recovery from COVID-19, according to a 2022 study in ScienceDirect. Diabetes was present in 94% of the COVID-19-related mucormycosis cases included in a 2022 study published in the Journal of Family Medicine and Primary Care.

What Are the Symptoms of Mucormycosis?

Symptoms can vary depending on where in the body someone is infected.

If a person's sinus and brain are infected (rhinocerebral mucormycosis), they may experience the following symptoms:

  • One-sided facial swelling
  • Headache
  • Nasal or sinus congestion
  • Black lesions on the nasal bridge or upper inside of the mouth that quickly become more severe
  • Fever

Symptoms in the lungs (pulmonary mucormycosis) can include:

  • Fever
  • Cough
  • Chest pain
  • Shortness of breath

A skin infection (cutaneous mucormycosis) may have these symptoms:

  • Blisters
  • A black infected area
  • Pain
  • Warmth
  • Excessive redness
  • Swelling around a wound

Symptoms of mucormycosis in the gastrointestinal (GI) tract (gastrointestinal mucormycosis) can include:

  • Abdominal pain
  • Nausea and vomiting
  • Gastrointestinal bleeding

What Is the Treatment for Mucormycosis?

While this infection is rare, doctors emphasize that mucormycosis is a serious illness. "It's a nasty infection and can be very devastating if it is not detected early and treated," said Dr. Schaffner.

Mucormycosis is treated with antifungal medications, usually Abelcet (amphotericin B), Noxafil (posaconazole), or isavuconazole, given through an IV or by mouth. "A patient may also need surgery to cut out infected (or dead) tissue," said Dr. Russo.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up to date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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