Last week, there were several reports that emerged of black fungus cases in Sri Lanka. These cases were detected from patients infected with Covid-19. In that regard, I spoke to Professor Emeritus Lakshman Samaranayake, a clinical pathologist with over 350 publications globally on fungal diseases of the orofacial region; he is also the University of Hong Kong Immediate Past Dean of Dentistry.
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Professor Emeritus Lakshman Samaranayake[/caption]
Black fungus is an opportunistic infection, particularly affecting patients treated with steroids for Covid-19. Mucormycosis was rampant in India, and now, it has been reported in several hospitals in Sri Lanka. It has also been reported among those with diabetes, cancer, and conditions that weaken the immune system such as immunosuppression and cancer.
Explaining to us how some cases present, Prof. Samaranayake gave an example of a recent encounter from India, which reflects the seriousness of this condition.
“A 27-year-old male, treated for Covid-19 by steroids, who presented with swollen and protruding eyes, which, on examination, was affected by rhino-cerebral mucormycosis; the surgeons had to remove both his eyes subsequently.
“His colleagues at the Samadhan Dental Super Specialty Centre in Dhule, Maharashtra – oral and maxillofacial surgeons Rajesh and Shrenik Oswal – have, since April, treated nearly 50 former Covid-19 patients with mucormycosis of the jaw, 25 of whom have had their jaw fully or partially removed to stop the disease spread,” said Prof. Samaranayake.
What is mucormycosis?
First described in 1665 as “microfungus mucor”, it is a term used to describe rare opportunistic, life-threatening infections of the sinuses, brain, or lungs. Today, it has been found as a sequela of Covid-19 infection, with a high degree of morbidity and mortality. If left untreated, it can progress rapidly causing necrosis of tissue.
How do we contract it?
Fungal spores are commonly found in the environment. Every person on the planet inhales at least an estimated 1,000 fungal spores per day. It can be transmitted via inhalation, inoculation, and ingestion. It is important to note that this is a non-contagious disease and it doesn’t transmit by direct or indirect contact with someone. Fungal spores are present throughout the environment, particularly in soil, through decaying organic substrates, compost piles, animal dung, rotting wood, and plants.
What are the risk factors?
It’s usually seen in:
Professor Emeritus Lakshman Samaranayake[/caption]
Black fungus is an opportunistic infection, particularly affecting patients treated with steroids for Covid-19. Mucormycosis was rampant in India, and now, it has been reported in several hospitals in Sri Lanka. It has also been reported among those with diabetes, cancer, and conditions that weaken the immune system such as immunosuppression and cancer.
Explaining to us how some cases present, Prof. Samaranayake gave an example of a recent encounter from India, which reflects the seriousness of this condition.
“A 27-year-old male, treated for Covid-19 by steroids, who presented with swollen and protruding eyes, which, on examination, was affected by rhino-cerebral mucormycosis; the surgeons had to remove both his eyes subsequently.
“His colleagues at the Samadhan Dental Super Specialty Centre in Dhule, Maharashtra – oral and maxillofacial surgeons Rajesh and Shrenik Oswal – have, since April, treated nearly 50 former Covid-19 patients with mucormycosis of the jaw, 25 of whom have had their jaw fully or partially removed to stop the disease spread,” said Prof. Samaranayake.
What is mucormycosis?
First described in 1665 as “microfungus mucor”, it is a term used to describe rare opportunistic, life-threatening infections of the sinuses, brain, or lungs. Today, it has been found as a sequela of Covid-19 infection, with a high degree of morbidity and mortality. If left untreated, it can progress rapidly causing necrosis of tissue.
How do we contract it?
Fungal spores are commonly found in the environment. Every person on the planet inhales at least an estimated 1,000 fungal spores per day. It can be transmitted via inhalation, inoculation, and ingestion. It is important to note that this is a non-contagious disease and it doesn’t transmit by direct or indirect contact with someone. Fungal spores are present throughout the environment, particularly in soil, through decaying organic substrates, compost piles, animal dung, rotting wood, and plants.
What are the risk factors?
It’s usually seen in:
- Someone who had Covid-19 or other severe viral diseases;
- Immunodeficiency disorders;
- Cancers
- Someone taking immunosuppressive medications
- Immunosuppressed individuals in general
- Those who have hematologic malignancies (75% of cases encountered are due to this);
- Hemochromatosis (a condition in which your body stores too much iron);
- Uncontrolled diabetes mellitus with or without ketoacidosis
- Those who have undergone an organ transplantation;
- Severe burns or trauma;
- Prolonged corticosteroid therapy
- Pulmonary (lung) – most common in cancer patients with stem cell or organ transplants
- Rhinocerebral (sinus and brain) – common in patients with uncontrolled diabetes and kidney transplant patients, and now Covid-19, possibly due to steroid therapy
- Cutaneous (skin) – skin infection. When fungi enter the body through burns or any type of skin injury. Common among people who do not have weakened immune systems
- Gastrointestinal – common among low-birth-weight and premature infants aged less than one month, with surgery or on medications that lower the immunity
- Disseminated – commonly affects the brain, other body parts, and organs such as the heart, spleen, and skin
- Throbbing headache and fever
- Facial, sinus, or nasal pain
- Redness of skin above sinuses
- Black nasal discharge
- One-sided swelling in the upper jaw
- Facial paralysis (occasional)
- Eyes that swell and protrude
- Dark scabbing in nasal cavities
- Toothache or loosening of teeth
- Black lesions on palatal areas
- Loss of vision
- Facial pain
- A serum-filled small bullae
- Skin ulcers or skin infection secondary to sinus infections
- Infected skin area turning black
- Warmth and excessive reddening
- Swelling around infected area
- Black lesion on nose bridge
- Intra oral: Palatal redness/brownish or black lesion
- White lesion: Necrotic bone
- Clinical findings by thorough intraoral and extra oral examination
- Radiographic evaluation using MRI, CT, and CBCT scan
- Biopsy and histological examination using KOH staining
- Culture of lesional tissue on Sabouraud’s agar
- Routine brushing at least twice or thrice a day
- Oral rinsing using a suitable mouthwash
- New toothbrush – change the toothbrush after recovery of an opportunistic fungal infection (to avoid possible reinfection from the old toothbrush)
- Disinfect the toothbrush and tongue cleaner
- Do not keep the toothbrush and tongue cleaner in the same holder of their other family members
- Clean the brush and tongue cleaner using an antiseptic mouthwash