A dangerous but rare infection caused by a tissue-blackening fungus has global health authorities on edge. The alarm bells are ringing because mucormycosis, also known as black fungus, has a high incidence among sick and recovered Covid-19 patients.

At least 19 regions of India have already raised in the last two months to epidemic status the advance of this disease, which has more than 14,000 diagnoses in that country, and areas of the world such as America are already reporting, although limited, several cases of infections.

This concern is also growing because its mortality rate ranges from 40% to 80%, depending on the patient’s underlying conditions.

But what is it, how is it treated, is it contagious between humans and, more importantly, what is the real risk that its spread will aggravate the current coronavirus pandemic?

A ubiquitous fungus

Black fungus, formerly called zygomycosis, is by definition a serious but rare fungal infection that is caused by a group of molds called mucormycetes.

The U.S. Centers for Disease Control and Prevention (CDC) explains that these fungi are very common and “live throughout the environment,” particularly in soil and decaying organic matter.

There are several types of this infection depending on the region of the body they attack, such as rhinocerebral (sinus and brain), pulmonary, gastrointestinal or skin-infesting.

How is it acquired?

The first thing to know is that humans acquire mucormycosis by coming into contact with fungal spores present in the air and in the environment. It can also occur on the skin “after a cut, burn or other skin lesion,” the CDC says, but it is not transmitted from person to person.

Secondly, mucormycosis mainly affects patients with underlying health problems, such as diabetes or AIDS, or who take drugs that reduce the body’s ability to fight germs and diseases, as in the case of Covid patients.

In fact, the consultation document known as the Merck Sharp & Dohme (MSD) Pharmaceutical Manual clarifies that “the spores of these molds are likely to be constantly aspirated, but they do not usually cause infection”.

This is an infection that has been known to physicians since before the pandemic, so effective diagnostic methods are available worldwide.

Mucormycosis and Covid-19

In recent months, an increase in cases of mucormycosis has been observed in patients with Covid-19 and the highest number of cases was reported in India.

The CDC reminds that it is feasible that “some patients may have Covid-19 and a fungal infection at the same time,” but specialized testing is needed as fungal diseases can share symptoms with coronavirus such as fever, cough or respiratory distress.

Indeed, the main warning signs of murcomycosis are these, plus one-sided facial swelling, headache, nasal congestion and black lesions on the bridge of the nose or upper inside of the mouth.

India, the big picture – America in danger?

India, which remains the country with the most new cases of coronavirus in the world, with 1.3 million in the last week, is also the focus of an increase in murcomycosis diagnoses.

In a letter sent to The Lancet Respiratory Medicine and published June 3, scientists have warned that “as India continues to achieve stability over the existing (Covid) situation, another imminent threat in the form of coronavirus-associated disease, murcormycosis, has emerged.”

In view of this rapid increase, the Indian central government is sending the drug amphotericin B, the main treatment for the disease in addition to surgery to remove infected tissues, to all affected states and has banned the transmission of other control information without government authorization.

Meanwhile, America, another focal point of the Covid-19 pandemic, has also registered several cases.
There are public reports of well-documented cases in the USA, Brazil, Mexico, Paraguay and Uruguay, but the number of reports is very limited, even counting on the Latin American Network for Antimicrobial Resistance Surveillance (ReLAVRA), which receives these figures.

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