What Is Mucormycosis? India Saw a Rise in Potentially Fatal Fungal Infections During the 2021 COVID-19 Surge

The infection mainly affects people who are immunocompromised.

In May 2021, India experienced a devastating COVID-19 surge. To make matters worse, the country started seeing a rise in another potentially deadly illness called mucormycosis, also referred to as "black fungus". And while you've probably never even heard of mucormycosis before, doctors say it can and does happen in the US—it's just rare. 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). And while the infection itself may be rare, the molds themselves are not. "The fungus that causes it is in the environment everywhere you look," infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, told Health.

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

People usually develop mucormycosis after breathing in the fungal spores from the air, which then get into their sinuses and lungs, Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo in New York, told Health. However, it's also possible to get it through the skin after having a cut, burn, or other injuries, Cindy Wassef, MD, assistant professor at the Rutgers Center for Dermatology, told Health. "The fungi that cause mucormycosis are often found in soil or rotting vegetables, fruits, and bread," said Dr. Wassef.

In general, mucormycosis isn't a common infection. "Infectious disease doctors are familiar with it, but it is rare, fortunately," William Schaffner, MD, an infectious disease specialist, and professor at the Vanderbilt University School of Medicine, told Health. In the US, for example, the CDC says it often investigates one to three cases of mucormycosis clusters linked to certain groups of people, like those who have had an organ transplant.

Why Did Mucormycosis Cases Increase in India?

There does seem to be a connection between COVID-19 and mucormycosis. According to Dr. Adalja, people are most at risk of contracting mucormycosis when they're immunosuppressed—and that can include after having a serious illness like COVID-19. "We see it sometimes after severe influenza," said Dr. Adalja.

People with more severe forms of COVID-19 are often treated with steroid medications, which can also suppress the immune system, opening them up to fungal infections like mucormycosis, pointed out Dr. Russo. "That, and severe COVID-19 infections in and of itself might suppress the immune system even further," added Dr. Russo.

Case in point: In a 2021 study published in the journal Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, researchers found that 76.3% of the cases they reviewed had used steroids as part of their treatment for COVID-19.

And just as having comorbidities, such as diabetes, cancer, and heart disease, increases the chances of severe COVID-19, studies suggest that having these same comorbidities also seems to increase the risk of contracting mucormycosis during recovery from COVID-19. Several literature reviews pointed to diabetes as being one of the comorbidities that presents the highest risk of contracting mucormycosis. In that same 2021 study, for example, researchers found that diabetes was present in 80% of the COVID-19-related mucormycosis cases included in the review.

What Are the Symptoms of Mucormycosis?

According to the CDC, 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 nasal bridge or upper inside of 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

How Is Mucormycosis Treated?

Mucormycosis is treated with anti-fungal medications, usually amphotericin B, posaconazole, or isavuconazole, per the CDC. They're often given through an IV or by mouth. "A patient may also need surgery to cut out infected tissue," said Dr. Russo.

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," stressed Dr. Schaffner.

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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